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Automated image analysis in RA
Richard Ljuhar
Friday, Feb. 1, 2019 · 4:04 p.m. · 22m 40s
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i think yeah much uh e. one else for for give me the chance to present here
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and again all what work is um person on trial is
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um so we billing and learning algorithms which we
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use uh apply x. rays to extract certain information what
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prediction about what all the classification of the disease
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um i think i have to give a lot utilities numbers uh
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and summer you're is it's it's a lot of patients being effect but is uh try to
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a to a tight is you know it has general is r. a. or all way
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and he likes and on what these diseases all have in common and is that that imaging
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uh is performed usually easy to hand is the knee is it um any other extremity um
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and what we have seen here um my my teammate image types of that is that
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um this whole is x. ray diagnoses uh which are
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performed by physicians are usually quite subjective underperformed manually
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i'm very often depending on the experience of decision was off that
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day you know and time that that uh analysis being performed
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and it's very often results at least what we've seen the case of last friday's in a
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quite nonspecific treatment and we believe that um they are always out there to change that
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so basically if you look at our applications let's say the field off you know lot testing than automation
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automated analyses is a standard right you wouldn't find anyone looking you know that incoming cells anymore
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um but unfortunately if you look at a few of radiology not peaks
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and the way how be assessed x. rays nowadays is um as one of our
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our doctors uses said i i was the said it's it's almost like a hundred years ago
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so with the x. ray and we come up with a conclusion and medication comes back
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you two years later began more less you look at it and then try to find out what has changed
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and our approach was um to um kind of like a work from um to change it actually is that
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we are actually can look into from a really active model which means that the patient comes to us
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uh we look at the x. ray and we say well there is something i come back
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actually when you know it's getting worse um that we go more to a proactive model
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well we actually say well they are certain signs here which put it as a risk factor
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are there certain anomalies in the x. ray basin that we started preventive treatments much sooner
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uh or exact final exam would be retractable question much more
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accurately did we say well you wait what's that direction
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uh and based on that we can actually do something about that right and just waiting until um you know the page when it comes
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to us with we see a pain so basically does what we are
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doing um he again on the sample often e. x. ray
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um where we actually use 'em weighting schemes like a lawrence score
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for example and again this is your focusing on osteoarthritis
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but we take the x. ray instead of doing it manually design and um we have a
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software trained a base on the learning machine learning as we heard the previous talks
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actually i take 'em all these men of measurements of the catalan score and put
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it into a detail disease report um within you just if you sex actually
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so um is you just screen job as screen shot of a recent the integration of our software
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so basically you see here um the pain protocol where you see on the right side uh we just study
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uh and then you see here a feature the the nice then hear the annotations by the software
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um basically um we we remove that information initially they were like all kinds
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of different from a she about you know ah suffice colour rose
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in the likes so we actually kept quite simple based on the phoebe
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from the radiologists which just show um the cable on score
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and then there's the report here with all the the the uh was
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equating the likes which i will go to multichannel next slide
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so what is the output of um that software again you see the final played catalan
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score for each of you know if he's a bilateral needs for each side
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uh yeah he was a great as well and so it's a combination of cattle lawrence and was it
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um then you have here in the lower part the report a great detail
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measurements and and what we measure here are different and anatomical parameters
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a joint space with joint space area which is quite indirect measurement of the cottage area
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uh and what we ought to do here uh we have twenty algorithm to ah chi like i'm i'm
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kinda calibrated for the distance you know the difference is a distance right so if a patient
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stay still closed the tact or for out all the does have an impact on the measurements
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and what we trained our software on was to compensate for these
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measurements have uh what we call the standardised quantitative measurements
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unless the of course uh what our goal was to provide to position a
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a comparison to uh this case it would be left to right knee
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but of course going for guide you would be that um the we all
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just get the x. ray this can swing form and what your
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feeling would get the end would be um that's and i support here and if the patient comes back a year two years later
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um you can compare again you know either the final kale kale school or or uh
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the sops course uh for joint space now rings the roses and austin fights
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so here are just a some performance i cover sticks uh this offer is currently undergoing f.
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d. a. approval so we went for all these uh validation sets uh and the likes
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uh so for the confusion matrix is here the cattle lawrence great of course to detect if a
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patient has away another way is um is um you know quite good the accuracy sensitivity specificity
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where it becomes tricky as we heard a previously is especially in the early um
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uh early some uh uh some of the disease scale one and two
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we can see here um so that you know the two living here you see it it's
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it's quite difficult to differentiate between one and two uh here especially scary here
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but then when we go out for up to kayla three and four
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uh the softer becomes much better in the green with with the ground truth actually
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and this is based on the data set of roughly four thousand patients uh for your follow ups
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so roughly fifteen thousand images which we collected a large uh us uh um multi centre study
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we can perform there we decided so we said okay you know the software's here um we know that there is
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a a you didn't rape can position so does a soft actually change something in terms of the grid positions
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uh for this purpose we uh selected a random sample of her thirty six x. rays
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we gave to position the plane x. ray and then we gave to position the same x. ray of course in different order
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with the softer generate a report next it and ask position you do you agree with that or not
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uh and basically see here um based on on the couple score is that you know
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the the undated agreement between that with the specialists is here mark in in blue
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um and then when they had the software with it then it was you know we get us um and improvement
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in in each of these categories with exactly germans was nearing with a already agree without the softer very good
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so was as a gift improvement each of these categories when a position actually
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had to hang protocol at realised um report next to the x. ray
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then uh with a big women rate um how do you agree uh between each
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other and you see here the the blue circle one is the unaided uh
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version and then if we gave them the the the report annex
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it then uh we also saw that and still improvement
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in a pretty much each of the categories so in other words and to position had something extreme where software
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kinda gave you the every indication then uh and they start to agree more uh with each other
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and initially the initial trial we had with k. loans wars that um the only get thirty percent
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of cases so um so that was actually reading the we just study a big improvement
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as to this is of course weren't you know fully blinded to what they are actually should uh should be doing
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i'm not this is really just um to support uh without is of predicts the way you know you wanna
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great certain common feature of the x. ray but not a question is can we also try this information
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can we keep the decision information where they say well it might became learns to um
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but you know are you the high risk of developing or you're not away
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um and for that purpose our initial focus was on text analysis to use that as a
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as an additional uh the data point either source in the uh in the image analysis
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and actually texan else's is something which do not differ quite sometime most being used in the field of
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false crosses detect uh the risk of a factor so we did basically we looked at um
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again at a large uh us study where we had a baseline and follow up a data available
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that and want to know um if we have a a base like with patients um
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what what is the accuracy we can uh we can achieve to
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then if i within these baseline groups all kills zero um
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that you know how many of these patients actually will have kale large in one um in eighty four month follow up
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today was the i'd hear a um and what we did then we build different models
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look at uh things like a clinical risk factors section houses joint
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space with with a lot and so on so on
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and imply that all the results um and um what we see here is we
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say five of male and female we saw difference between these two groups
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um what you see here the blue line actually is here on on the look it females is the the
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standard model way just have that little factors joint space with p. m. i. h. and and the likes
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then if you just look at text analysis um so if you look at now um the
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bone mike architecture as a as a i would say then the production mode likes
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increased in other words um we went up from legacy of predicting which patient will be
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in the progress or group from zero point six seven two zero point seven eight
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and if we combine text analysis uh see here uh at the bottom
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i take announces with him i joined space with and all the other factors
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we achieved next c. of your point eight in predicting which of these patients in the
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k. l. zero group actually we'll have yellow one higher identity foreman for awhile
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the male group uh perform worse and we believe the main reason ever is that we
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just had you know a very small sample size uh from from male patients
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the main issue with protection else's though is that it's quite sensitive to the image parameters um
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so you know playing on the large data set with different eczema dell is kinda tricky
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so what we did as far as the next that actually was look at alternative such as the planning for example
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uh and we use a day the same data set and uh
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we were able to achieve almost the same results already
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um so we're at seventy eight percent accuracy so far um and if you just compare that to
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uh the work so i think a static little later so be my joint space age
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um we already are we are performing the standard model with our keep learning model
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which has the benefit that it actually tells you also which of the regions you're in the x. say what you see here is blue
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patches you actually the areas in the x. ray pose the each individual patients
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what a net but actually take it that he's either the yeah areas we're
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at a form of follow up they will be a change happened
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and so it it it's quite uh quite um and need to result here we
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gonna presented at u. c. r. and in two weeks actually the or presentation
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um but what other tools have we have to look that way half we can
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apply these these these these these networks these people networks on other applications
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i'm and r. a. of course we had already met previous presentation is something which very interesting
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and again the same approach as with oscar tried is uh the first there was to use text analysis
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to see if we can use text analysis to extract certain information or the
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x. ray which helps their remote apologies to predict or the the progression
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uh and initial results here against small a small sample size where a promising um
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so so we are now expanding on that data set we have a another these which is much larger
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and we do basically here is um in the first step is to automate the input data
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um so basically um we have train the net work to um you know measure joint space with for
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example and also detect contours which we don't data uh use for actually um the rose detection
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uh and this this is just a mock up this this report you don't be some pay attention
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it's really just what what the software does what we have tried the software on to detect
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um then again um but we can only do we look at the sharp
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score um to see um can we actually train a network to detect
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on on which of the joints actually there is our already progression happening
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uh and and of course uh the next it would be to use that to predict are a but that's where we are
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right now so far it's really just a message on space with uh and to really assess the shark score automatically
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um and application um is really just it's all it's all the same
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concept basically to use it people networks and just give them instead
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of hip a hand or a instead of any hand or hip
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this case for example uh we look at catalogues measurements indicate
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uh the first again is measured joint space with and then go again
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uh also fights uh as closes all those kind of things
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um and then you know what is and uh it was a nice ipods was
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all the match automatic angles so you know the softer actually detects you
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also contour second place an ad for the angles here so you know do
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it all just doesn't have to mentally i click on the x. ray
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um and then the last pet project it doesn't really fit so much it it is a it is topic but it's
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really something which we work on just a month ago so work on that we're look at bone age assessment
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um and um we have done we spend so much work in a few of
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austria fridays um that we just thought you know hey now we have hand
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now if your hands can be actually used what we have falsified is all the different with different feel
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and just within a month actually i we were able to train at work to uh assess people in h. a.
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uh in um you know with a with a with a with a range of plus minus five months
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next this was um the winning cattle competition at our slate was eighteen actually was that range
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so that shows you that showed us that you know if we have the proper image data
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or you can apply these algorithms to almost any you know any any any data or
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um but what is all important and what i must stress again we were before is it's all the input data
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and this was it they're nice sample set with very clean input data are and
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if you don't have that um you will not was a achieve such results
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yeah in conclusion and the outlook reform from our point of
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view is that these these people earning oh digital um
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the technology is uh actually can provide crime savings by
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automate automating uh so far pretty mellow process
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we don't see the change of work was necessary these things one the background now we really became mature he you
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know half ago two years ago it was very tedious now
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these things um our um have become like grownups
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um this whole solicitation an object reporting really we have seen does actually have
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an impact so we think that is really adds value to it
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um outcome measures is something which would you quite often do we know what
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you mean is working not how can we actually track um the effectiveness
00:16:05
um things like a second opinion i'm in breast cancer these things are very common
00:16:10
innovative of pubic somewhat taller gee we're not there yet but you believe that you know
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the time is ripe with these things also um our news more often that field
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keep track of treatment changes i mentioned for sure and unless of course increase agreement between
00:16:26
readers and when i saw for your provides a a first reading on this
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yeah with this i wanna kind of presentation and um
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i think you can for time thank you how
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honking which are a a question from the audience
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a half want to start a new one just that he was saying comparing different model
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it was like a each joint be emma it's on and then just
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like uh was texture the so that was the first plaza second
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um i'm i was quite surprised to see that combining the first and second
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doesn't really improve significantly easy outcome because you move a a you see from seventy
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eight to eighty which is clearly not significant uh you don't have the
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confidence interval that pretty sure yep so so does it mean that most of
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the performance agree that budget texture and the rest is just like
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minor adults or does it mean that a sample size or how would you
00:17:32
explain that because maybe the focus should be on the texture only
00:17:36
and the rest is just okay now i have but not ready of added that yeah no i i do that with you
00:17:42
and and that was why we showed it was because we can like no question if faction as we add that much value
00:17:49
but we've seen that i'm actually really i provide information which you know the human eye um conflict or the x. ray
00:17:56
so we think that this certainly is the way to go and the reason i moved all the loading
00:18:01
is because we find it difficult to calibrate you know that images according to set the standard
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and we've seen that with deep learning on the algorithms are the stage where
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could easier work with x. wasn't even without this but if they would be a single standard in x.
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rays then text analysis that we would be superior to most of the current her measurements we're using
00:18:27
so thank you very much is a pretty brilliant presentation very nice and uh i
00:18:31
have a particular interest in house or try to so actually want to ask
00:18:34
you is so from the most study what if an animal studies they actually
00:18:38
also look at at bomber lesions and mostly i'm right imaging obviously we
00:18:42
i song or high but not not most sorry about the most l. c. look
00:18:46
at us undivided okay yeah sorry yeah yeah okay yeah so i was
00:18:50
wondering so they are they found actually that were some and arrive features that
00:18:54
that they found predictive for development of radio graphical way later on
00:18:58
i was wondering how does this compare to your bone textual measurements can
00:19:02
you detected pretty early on and a second question would be
00:19:05
when using a production algorithm or you saw that most of the changeable taking place that either at the middle of the t. v. or
00:19:12
or at the edge of the of the bone but not in the central part where
00:19:15
normally would have a a college last do you have any uh explanation for that
00:19:20
um so so the first question um so we we just we're just signs look now into into these correlations
00:19:27
um what the work with the right now is to um actually look into
00:19:31
can we um predict or detectable male lesions on conventional x. rays
00:19:37
so in the away i study for example they had that correlations also you know we're trying
00:19:41
to detect a certain area based on an x. rating keep that back to that position
00:19:46
um i think is a very interesting um research question which we're looking wrote
00:19:50
to right now i hope i have no more results sometimes you know
00:19:54
we end this year um to the uh to the uh second question
00:19:59
i can give you an explanation uh why's that uh we you know if that old information to network and then
00:20:05
it's the little black box right they give you something out and you don't really know why these like that
00:20:10
so uh we need understand more you know the better way why that came that conclusion
00:20:15
and i think the key that will be the chip we have um more image data sets like you i like the most to repeat that and see
00:20:21
if these results are actually know almost same different patient populations for example
00:20:30
could be could be yes i've just the previous question um with the with the shop score this
00:20:36
shining pictures with the what is this a heat that yes and i'm just i don't know
00:20:42
what you think but for me when we see something shining on an x. ray or c. t.
00:20:47
we think about aspects eighteen so i'll still plus or packed a a close up take
00:20:54
but but this is beta thing right this shining it's it's
00:20:57
confusing me but amazingly it's and it makes me what
00:21:02
does this do with us how it it's that it's i'm
00:21:06
coming from and more like data science background um
00:21:09
those are concert would you use for different applications so on
00:21:13
but we still need to do to understand what the decision in what kind of formed a physician would like that information
00:21:19
the deal was really just to give him his position id or um on
00:21:23
the house you've your discharge was based on uh he met right um
00:21:28
i'm not too happy about that because we on it was it it's an specific matter right
00:21:33
um so i think they need to be more input from physicians well product exact i think that's a clinician i
00:21:38
would like to have this in future he met matt on the x. ray to see where is the emotion
00:21:45
sit here on the still a process or maybe i am check there for example
00:21:50
so uh that's something we need to yeah okay so so i can yeah i that
00:21:53
that's that's what we're not actually sure about with that with them that way production
00:21:58
and then and that you will works there we use the same concept with heat network show these
00:22:03
are the regions where it will compress the future above are a we actually just early on
00:22:10
alright so thank you very much so ah ha ha
00:22:17
that's why we're here to uh what uh what might go
00:22:21
from copenhagen i don't read the name of university because
00:22:26
um is too complicated for me i'm sorry i don't want to uh to be rude on that plane
00:22:31
and uh she would present a electro so he has one letter g.
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