scholarly journals Automated Clinical Decision Support for Coronary Plaques Characterization from Optical Coherence Tomography Imaging with Fused Neural Networks

Optics ◽  
2022 ◽  
Vol 3 (1) ◽  
pp. 8-18
Author(s):  
Haroon Zafar ◽  
Junaid Zafar ◽  
Faisal Sharif

Deep Neural Networks (DNNs) are nurturing clinical decision support systems for the detection and accurate modeling of coronary arterial plaques. However, efficient plaque characterization in time-constrained settings is still an open problem. The purpose of this study is to develop a novel automated classification architecture viable for the real-time clinical detection and classification of coronary artery plaques, and secondly, to use the novel dataset of OCT images for data augmentation. Further, the purpose is to validate the efficacy of transfer learning for arterial plaques classification. In this perspective, a novel time-efficient classification architecture based on DNNs is proposed. A new data set consisting of in-vivo patient Optical Coherence Tomography (OCT) images labeled by three trained experts was created and dynamically programmed. Generative Adversarial Networks (GANs) were used for populating the coronary aerial plaques dataset. We removed the fully connected layers, including softmax and the cross-entropy in the GoogleNet framework, and replaced them with the Support Vector Machines (SVMs). Our proposed architecture limits weight up-gradation cycles to only modified layers and computes the global hyper-plane in a timely, competitive fashion. Transfer learning was used for high-level discriminative feature learning. Cross-entropy loss was minimized by using the Adam optimizer for model training. A train validation scheme was used to determine the classification accuracy. Automated plaques differentiation in addition to their detection was found to agree with the clinical findings. Our customized fused classification scheme outperforms the other leading reported works with an overall accuracy of 96.84%, and multiple folds reduced elapsed time demonstrating it as a viable choice for real-time clinical settings.

Author(s):  
Ana Margarida Pereira ◽  
Cristina Jácome ◽  
Rita Amaral ◽  
Tiago Jacinto ◽  
João A Fonseca

2020 ◽  
Vol 27 (12) ◽  
pp. 1968-1976
Author(s):  
Anna Ostropolets ◽  
Linying Zhang ◽  
George Hripcsak

Abstract Objective A growing body of observational data enabled its secondary use to facilitate clinical care for complex cases not covered by the existing evidence. We conducted a scoping review to characterize clinical decision support systems (CDSSs) that generate new knowledge to provide guidance for such cases in real time. Materials and Methods PubMed, Embase, ProQuest, and IEEE Xplore were searched up to May 2020. The abstracts were screened by 2 reviewers. Full texts of the relevant articles were reviewed by the first author and approved by the second reviewer, accompanied by the screening of articles’ references. The details of design, implementation and evaluation of included CDSSs were extracted. Results Our search returned 3427 articles, 53 of which describing 25 CDSSs were selected. We identified 8 expert-based and 17 data-driven tools. Sixteen (64%) tools were developed in the United States, with the others mostly in Europe. Most of the tools (n = 16, 64%) were implemented in 1 site, with only 5 being actively used in clinical practice. Patient or quality outcomes were assessed for 3 (18%) CDSSs, 4 (16%) underwent user acceptance or usage testing and 7 (28%) functional testing. Conclusions We found a number of CDSSs that generate new knowledge, although only 1 addressed confounding and bias. Overall, the tools lacked demonstration of their utility. Improvement in clinical and quality outcomes were shown only for a few CDSSs, while the benefits of the others remain unclear. This review suggests a need for a further testing of such CDSSs and, if appropriate, their dissemination.


PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262193
Author(s):  
Monica I. Lupei ◽  
Danni Li ◽  
Nicholas E. Ingraham ◽  
Karyn D. Baum ◽  
Bradley Benson ◽  
...  

Objective To prospectively evaluate a logistic regression-based machine learning (ML) prognostic algorithm implemented in real-time as a clinical decision support (CDS) system for symptomatic persons under investigation (PUI) for Coronavirus disease 2019 (COVID-19) in the emergency department (ED). Methods We developed in a 12-hospital system a model using training and validation followed by a real-time assessment. The LASSO guided feature selection included demographics, comorbidities, home medications, vital signs. We constructed a logistic regression-based ML algorithm to predict “severe” COVID-19, defined as patients requiring intensive care unit (ICU) admission, invasive mechanical ventilation, or died in or out-of-hospital. Training data included 1,469 adult patients who tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within 14 days of acute care. We performed: 1) temporal validation in 414 SARS-CoV-2 positive patients, 2) validation in a PUI set of 13,271 patients with symptomatic SARS-CoV-2 test during an acute care visit, and 3) real-time validation in 2,174 ED patients with PUI test or positive SARS-CoV-2 result. Subgroup analysis was conducted across race and gender to ensure equity in performance. Results The algorithm performed well on pre-implementation validations for predicting COVID-19 severity: 1) the temporal validation had an area under the receiver operating characteristic (AUROC) of 0.87 (95%-CI: 0.83, 0.91); 2) validation in the PUI population had an AUROC of 0.82 (95%-CI: 0.81, 0.83). The ED CDS system performed well in real-time with an AUROC of 0.85 (95%-CI, 0.83, 0.87). Zero patients in the lowest quintile developed “severe” COVID-19. Patients in the highest quintile developed “severe” COVID-19 in 33.2% of cases. The models performed without significant differences between genders and among race/ethnicities (all p-values > 0.05). Conclusion A logistic regression model-based ML-enabled CDS can be developed, validated, and implemented with high performance across multiple hospitals while being equitable and maintaining performance in real-time validation.


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