arXiv subjects

Bram Ruijsink

Publications and source records attributed to Bram Ruijsink.

30 records · Page 2Linked to original sources

arXiv2021

Quality-aware Cine Cardiac MRI Reconstruction and Analysis from Undersampled k-space Data

Cine cardiac MRI is routinely acquired for the assessment of cardiac health, but the imaging process is slow and typically requires several breath-holds to acquire sufficient k-space profiles to ensure good image quality. Several undersampling-based reconstruction techniques have been proposed during the last decades to speed up cine cardiac MRI acquisition. However, the undersampling factor is commonly fixed to conservative values before acquisition to ensure diagnostic image quality, potentially leading to unnecessarily long scan times. In this paper, we propose an end-to-end quality-aware cine short-axis cardiac MRI framework that combines image acquisition and reconstruction with downstream tasks such as segmentation, volume curve analysis and estimation of cardiac functional parameters. The goal is to reduce scan time by acquiring only a fraction of k-space data to enable the reconstruction of images that can pass quality control checks and produce reliable estimates of cardiac functional parameters. The framework consists of a deep learning model for the reconstruction of 2D+t cardiac cine MRI images from undersampled data, an image quality-control step to detect good quality reconstructions, followed by a deep learning model for bi-ventricular segmentation, a quality-control step to detect good quality segmentations and automated calculation of cardiac functional parameters. To demonstrate the feasibility of the proposed approach, we perform simulations using a cohort of selected participants from the UK Biobank (n=270), 200 healthy subjects and 70 patients with cardiomyopathies. Our results show that we can produce quality-controlled images in a scan time reduced from 12 to 4 seconds per slice, enabling reliable estimates of cardiac functional parameters such as ejection fraction within 5% mean absolute error.

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arXiv2021

Fairness in Cardiac MR Image Analysis: An Investigation of Bias Due to Data Imbalance in Deep Learning Based Segmentation

The subject of "fairness" in artificial intelligence (AI) refers to assessing AI algorithms for potential bias based on demographic characteristics such as race and gender, and the development of algorithms to address this bias. Most applications to date have been in computer vision, although some work in healthcare has started to emerge. The use of deep learning (DL) in cardiac MR segmentation has led to impressive results in recent years, and such techniques are starting to be translated into clinical practice. However, no work has yet investigated the fairness of such models. In this work, we perform such an analysis for racial/gender groups, focusing on the problem of training data imbalance, using a nnU-Net model trained and evaluated on cine short axis cardiac MR data from the UK Biobank dataset, consisting of 5,903 subjects from 6 different racial groups. We find statistically significant differences in Dice performance between different racial groups. To reduce the racial bias, we investigated three strategies: (1) stratified batch sampling, in which batch sampling is stratified to ensure balance between racial groups; (2) fair meta-learning for segmentation, in which a DL classifier is trained to classify race and jointly optimized with the segmentation model; and (3) protected group models, in which a different segmentation model is trained for each racial group. We also compared the results to the scenario where we have a perfectly balanced database. To assess fairness we used the standard deviation (SD) and skewed error ratio (SER) of the average Dice values. Our results demonstrate that the racial bias results from the use of imbalanced training data, and that all proposed bias mitigation strategies improved fairness, with the best SD and SER resulting from the use of protected group models.

cs.CV↗

arXiv2020

Quality-aware semi-supervised learning for CMR segmentation

One of the challenges in developing deep learning algorithms for medical image segmentation is the scarcity of annotated training data. To overcome this limitation, data augmentation and semi-supervised learning (SSL) methods have been developed. However, these methods have limited effectiveness as they either exploit the existing data set only (data augmentation) or risk negative impact by adding poor training examples (SSL). Segmentations are rarely the final product of medical image analysis - they are typically used in downstream tasks to infer higher-order patterns to evaluate diseases. Clinicians take into account a wealth of prior knowledge on biophysics and physiology when evaluating image analysis results. We have used these clinical assessments in previous works to create robust quality-control (QC) classifiers for automated cardiac magnetic resonance (CMR) analysis. In this paper, we propose a novel scheme that uses QC of the downstream task to identify high quality outputs of CMR segmentation networks, that are subsequently utilised for further network training. In essence, this provides quality-aware augmentation of training data in a variant of SSL for segmentation networks (semiQCSeg). We evaluate our approach in two CMR segmentation tasks (aortic and short axis cardiac volume segmentation) using UK Biobank data and two commonly used network architectures (U-net and a Fully Convolutional Network) and compare against supervised and SSL strategies. We show that semiQCSeg improves training of the segmentation networks. It decreases the need for labelled data, while outperforming the other methods in terms of Dice and clinical metrics. SemiQCSeg can be an efficient approach for training segmentation networks for medical image data when labelled datasets are scarce.

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arXiv2020

Interpretable Deep Models for Cardiac Resynchronisation Therapy Response Prediction

Advances in deep learning (DL) have resulted in impressive accuracy in some medical image classification tasks, but often deep models lack interpretability. The ability of these models to explain their decisions is important for fostering clinical trust and facilitating clinical translation. Furthermore, for many problems in medicine there is a wealth of existing clinical knowledge to draw upon, which may be useful in generating explanations, but it is not obvious how this knowledge can be encoded into DL models - most models are learnt either from scratch or using transfer learning from a different domain. In this paper we address both of these issues. We propose a novel DL framework for image-based classification based on a variational autoencoder (VAE). The framework allows prediction of the output of interest from the latent space of the autoencoder, as well as visualisation (in the image domain) of the effects of crossing the decision boundary, thus enhancing the interpretability of the classifier. Our key contribution is that the VAE disentangles the latent space based on `explanations' drawn from existing clinical knowledge. The framework can predict outputs as well as explanations for these outputs, and also raises the possibility of discovering new biomarkers that are separate (or disentangled) from the existing knowledge. We demonstrate our framework on the problem of predicting response of patients with cardiomyopathy to cardiac resynchronization therapy (CRT) from cine cardiac magnetic resonance images. The sensitivity and specificity of the proposed model on the task of CRT response prediction are 88.43% and 84.39% respectively, and we showcase the potential of our model in enhancing understanding of the factors contributing to CRT response.

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arXiv2020

Deep Learning Based Detection and Correction of Cardiac MR Motion Artefacts During Reconstruction for High-Quality Segmentation

Segmenting anatomical structures in medical images has been successfully addressed with deep learning methods for a range of applications. However, this success is heavily dependent on the quality of the image that is being segmented. A commonly neglected point in the medical image analysis community is the vast amount of clinical images that have severe image artefacts due to organ motion, movement of the patient and/or image acquisition related issues. In this paper, we discuss the implications of image motion artefacts on cardiac MR segmentation and compare a variety of approaches for jointly correcting for artefacts and segmenting the cardiac cavity. The method is based on our recently developed joint artefact detection and reconstruction method, which reconstructs high quality MR images from k-space using a joint loss function and essentially converts the artefact correction task to an under-sampled image reconstruction task by enforcing a data consistency term. In this paper, we propose to use a segmentation network coupled with this in an end-to-end framework. Our training optimises three different tasks: 1) image artefact detection, 2) artefact correction and 3) image segmentation. We train the reconstruction network to automatically correct for motion-related artefacts using synthetically corrupted cardiac MR k-space data and uncorrected reconstructed images. Using a test set of 500 2D+time cine MR acquisitions from the UK Biobank data set, we achieve demonstrably good image quality and high segmentation accuracy in the presence of synthetic motion artefacts. We showcase better performance compared to various image correction architectures.

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arXiv2020

Automated quantification of myocardial tissue characteristics from native T1 mapping using neural networks with Bayesian inference for uncertainty-based quality-control

Tissue characterisation with CMR parametric mapping has the potential to detect and quantify both focal and diffuse alterations in myocardial structure not assessable by late gadolinium enhancement. Native T1 mapping in particular has shown promise as a useful biomarker to support diagnostic, therapeutic and prognostic decision-making in ischaemic and non-ischaemic cardiomyopathies. Convolutional neural networks with Bayesian inference are a category of artificial neural networks which model the uncertainty of the network output. This study presents an automated framework for tissue characterisation from native ShMOLLI T1 mapping at 1.5T using a Probabilistic Hierarchical Segmentation (PHiSeg) network. In addition, we use the uncertainty information provided by the PHiSeg network in a novel automated quality control (QC) step to identify uncertain T1 values. The PHiSeg network and QC were validated against manual analysis on a cohort of the UK Biobank containing healthy subjects and chronic cardiomyopathy patients. We used the proposed method to obtain reference T1 ranges for the left ventricular myocardium in healthy subjects as well as common clinical cardiac conditions. T1 values computed from automatic and manual segmentations were highly correlated (r=0.97). Bland-Altman analysis showed good agreement between the automated and manual measurements. The average Dice metric was 0.84 for the left ventricular myocardium. The sensitivity of detection of erroneous outputs was 91%. Finally, T1 values were automatically derived from 14,683 CMR exams from the UK Biobank. The proposed pipeline allows for automatic analysis of myocardial native T1 mapping and includes a QC process to detect potentially erroneous results. T1 reference values were presented for healthy subjects and common clinical cardiac conditions from the largest cohort to date using T1-mapping images.

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arXiv2019

Assessing the Impact of Blood Pressure on Cardiac Function Using Interpretable Biomarkers and Variational Autoencoders

Maintaining good cardiac function for as long as possible is a major concern for healthcare systems worldwide and there is much interest in learning more about the impact of different risk factors on cardiac health. The aim of this study is to analyze the impact of systolic blood pressure (SBP) on cardiac function while preserving the interpretability of the model using known clinical biomarkers in a large cohort of the UK Biobank population. We propose a novel framework that combines deep learning based estimation of interpretable clinical biomarkers from cardiac cine MR data with a variational autoencoder (VAE). The VAE architecture integrates a regression loss in the latent space, which enables the progression of cardiac health with SBP to be learnt. Results on 3,600 subjects from the UK Biobank show that the proposed model allows us to gain important insight into the deterioration of cardiac function with increasing SBP, identify key interpretable factors involved in this process, and lastly exploit the model to understand patterns of positive and adverse adaptation of cardiac function.

cs.LG↗

arXiv2019

Global and Local Interpretability for Cardiac MRI Classification

Deep learning methods for classifying medical images have demonstrated impressive accuracy in a wide range of tasks but often these models are hard to interpret, limiting their applicability in clinical practice. In this work we introduce a convolutional neural network model for identifying disease in temporal sequences of cardiac MR segmentations which is interpretable in terms of clinically familiar measurements. The model is based around a variational autoencoder, reducing the input into a low-dimensional latent space in which classification occurs. We then use the recently developed `concept activation vector' technique to associate concepts which are diagnostically meaningful (eg. clinical biomarkers such as `low left-ventricular ejection fraction') to certain vectors in the latent space. These concepts are then qualitatively inspected by observing the change in the image domain resulting from interpolations in the latent space in the direction of these vectors. As a result, when the model classifies images it is also capable of providing naturally interpretable concepts relevant to that classification and demonstrating the meaning of those concepts in the image domain. Our approach is demonstrated on the UK Biobank cardiac MRI dataset where we detect the presence of coronary artery disease.

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arXiv2019

Detection and Correction of Cardiac MR Motion Artefacts during Reconstruction from K-space

In fully sampled cardiac MR (CMR) acquisitions, motion can lead to corruption of k-space lines, which can result in artefacts in the reconstructed images. In this paper, we propose a method to automatically detect and correct motion-related artefacts in CMR acquisitions during reconstruction from k-space data. Our correction method is inspired by work on undersampled CMR reconstruction, and uses deep learning to optimize a data-consistency term for under-sampled k-space reconstruction. Our main methodological contribution is the addition of a detection network to classify motion-corrupted k-space lines to convert the problem of artefact correction to a problem of reconstruction using the data consistency term. We train our network to automatically correct for motion-related artefacts using synthetically corrupted cine CMR k-space data as well as uncorrupted CMR images. Using a test set of 50 2D+time cine CMR datasets from the UK Biobank, we achieve good image quality in the presence of synthetic motion artefacts. We quantitatively compare our method with a variety of techniques for recovering good image quality and showcase better performance compared to state of the art denoising techniques with a PSNR of 37.1. Moreover, we show that our method preserves the quality of uncorrupted images and therefore can be also utilized as a general image reconstruction algorithm.

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arXiv2018

Automatic CNN-based detection of cardiac MR motion artefacts using k-space data augmentation and curriculum learning

Good quality of medical images is a prerequisite for the success of subsequent image analysis pipelines. Quality assessment of medical images is therefore an essential activity and for large population studies such as the UK Biobank (UKBB), manual identification of artefacts such as those caused by unanticipated motion is tedious and time-consuming. Therefore, there is an urgent need for automatic image quality assessment techniques. In this paper, we propose a method to automatically detect the presence of motion-related artefacts in cardiac magnetic resonance (CMR) cine images. We compare two deep learning architectures to classify poor quality CMR images: 1) 3D spatio-temporal Convolutional Neural Networks (3D-CNN), 2) Long-term Recurrent Convolutional Network (LRCN). Though in real clinical setup motion artefacts are common, high-quality imaging of UKBB, which comprises cross-sectional population data of volunteers who do not necessarily have health problems creates a highly imbalanced classification problem. Due to the high number of good quality images compared to the relatively low number of images with motion artefacts, we propose a novel data augmentation scheme based on synthetic artefact creation in k-space. We also investigate a learning approach using a predetermined curriculum based on synthetic artefact severity. We evaluate our pipeline on a subset of the UK Biobank data set consisting of 3510 CMR images. The LRCN architecture outperformed the 3D-CNN architecture and was able to detect 2D+time short axis images with motion artefacts in less than 1ms with high recall. We compare our approach to a range of state-of-the-art quality assessment methods. The novel data augmentation and curriculum learning approaches both improved classification performance achieving overall area under the ROC curve of 0.89.

cs.CV↗

arXiv2018

Deep Learning using K-space Based Data Augmentation for Automated Cardiac MR Motion Artefact Detection

Quality assessment of medical images is essential for complete automation of image processing pipelines. For large population studies such as the UK Biobank, artefacts such as those caused by heart motion are problematic and manual identification is tedious and time-consuming. Therefore, there is an urgent need for automatic image quality assessment techniques. In this paper, we propose a method to automatically detect the presence of motion-related artefacts in cardiac magnetic resonance (CMR) images. As this is a highly imbalanced classification problem (due to the high number of good quality images compared to the low number of images with motion artefacts), we propose a novel k-space based training data augmentation approach in order to address this problem. Our method is based on 3D spatio-temporal Convolutional Neural Networks, and is able to detect 2D+time short axis images with motion artefacts in less than 1ms. We test our algorithm on a subset of the UK Biobank dataset consisting of 3465 CMR images and achieve not only high accuracy in detection of motion artefacts, but also high precision and recall. We compare our approach to a range of state-of-the-art quality assessment methods.

cs.CV↗

arXiv2018

Learning associations between clinical information and motion-based descriptors using a large scale MR-derived cardiac motion atlas

The availability of large scale databases containing imaging and non-imaging data, such as the UK Biobank, represents an opportunity to improve our understanding of healthy and diseased bodily function. Cardiac motion atlases provide a space of reference in which the motion fields of a cohort of subjects can be directly compared. In this work, a cardiac motion atlas is built from cine MR data from the UK Biobank (~ 6000 subjects). Two automated quality control strategies are proposed to reject subjects with insufficient image quality. Based on the atlas, three dimensionality reduction algorithms are evaluated to learn data-driven cardiac motion descriptors, and statistical methods used to study the association between these descriptors and non-imaging data. Results show a positive correlation between the atlas motion descriptors and body fat percentage, basal metabolic rate, hypertension, smoking status and alcohol intake frequency. The proposed method outperforms the ability to identify changes in cardiac function due to these known cardiovascular risk factors compared to ejection fraction, the most commonly used descriptor of cardiac function. In conclusion, this work represents a framework for further investigation of the factors influencing cardiac health.

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