Globally, in 2016, one out of eleven adults suffered from Diabetes Mellitus. Diabetic Foot Ulcers (DFU) are a major complication of this disease, which if not managed properly can lead to amputation. Current clinical approaches to DFU treatment rely on patient and clinician vigilance, which has significant limitations such as the high cost involved in the diagnosis, treatment and lengthy care of the DFU. We collected an extensive dataset of foot images, which contain DFU from different patients. In this paper, we have proposed the use of traditional computer vision features for detecting foot ulcers among diabetic patients, which represent a cost-effective, remote and convenient healthcare solution. Furthermore, we used Convolutional Neural Networks (CNNs) for the first time in DFU classification. We have proposed a novel convolutional neural network architecture, DFUNet, with better feature extraction to identify the feature differences between healthy skin and the DFU. Using 10-fold cross-validation, DFUNet achieved an AUC score of 0.962. This outperformed both the machine learning and deep learning classifiers we have tested. Here we present the development of a novel and highly sensitive DFUNet for objectively detecting the presence of DFUs. This novel approach has the potential to deliver a paradigm shift in diabetic foot care.
The use of automated telemedicine systems for DFU is still in its infancy. Notably, @cite_35 @cite_4 in 2015 developed an intelligent telemedicine system for detection of diabetic foot complications with the help of spectral imaging, infra-red thermal images and 3D surface reconstruction. However, to implement this system, there is a requirement of several expensive devices and specialist training to use these devices. Wang et. al. @cite_0 have used an image capture box to capture image data and determined the area of DFU using cascaded two staged Support Vector Machine based classification. They proposed the use of a super-pixel technique for segmentation and extracted the number of features to perform two staged classification. Although this system reported a promising result, it has not been validated on a large dataset. In addition, the image capture box is very impractical for data collection as there is need for contact of the patient's feet and box surface which would not be allowed in a healthcare setting because of concerns regarding infection control. In other significant work, @cite_12 perform the segmentation of DFU and surrounding skin on the full foot images.
@cite_0 @cite_35 @cite_4 @cite_12
2744115775 2564782580 2787531133 1983922716
Diabetic Foot Ulcer (DFU) is a major complication of Diabetes, which if not managed properly can lead to amputation. DFU can appear anywhere on the foot and can vary in size, colour, and contrast depending on various pathologies. Current clinical approaches to DFU treatment rely on patients and clinician vigilance, which has significant limitations such as the high cost involved in the diagnosis, treatment and lengthy care of the DFU. We introduce a dataset of 705 foot images. We provide the ground truth of ulcer region and the surrounding skin that is an important indicator for clinicians to assess the progress of ulcer. Then, we propose a two-tier transfer learning from bigger datasets to train the Fully Convolutional Networks (FCNs) to automatically segment the ulcer and surrounding skin. Using 5-fold cross-validation, the proposed two-tier transfer learning FCN Models achieve a Dice Similarity Coefficient of 0.794 ( @math 0.104) for ulcer region, 0.851 ( @math 0.148) for surrounding skin region, and 0.899 ( @math 0.072) for the combination of both regions. This demonstrates the potential of FCNs in DFU segmentation, which can be further improved with a larger dataset. Automated melanoma recognition in dermoscopy images is a very challenging task due to the low contrast of skin lesions, the huge intraclass variation of melanomas, the high degree of visual similarity between melanoma and non-melanoma lesions, and the existence of many artifacts in the image. In order to meet these challenges, we propose a novel method for melanoma recognition by leveraging very deep convolutional neural networks (CNNs). Compared with existing methods employing either low-level hand-crafted features or CNNs with shallower architectures, our substantially deeper networks (more than 50 layers) can acquire richer and more discriminative features for more accurate recognition. To take full advantage of very deep networks, we propose a set of schemes to ensure effective training and learning under limited training data. First, we apply the residual learning to cope with the degradation and overfitting problems when a network goes deeper. This technique can ensure that our networks benefit from the performance gains achieved by increasing network depth. Then, we construct a fully convolutional residual network (FCRN) for accurate skin lesion segmentation, and further enhance its capability by incorporating a multi-scale contextual information integration scheme. Finally, we seamlessly integrate the proposed FCRN (for segmentation) and other very deep residual networks (for classification) to form a two-stage framework. This framework enables the classification network to extract more representative and specific features based on segmented results instead of the whole dermoscopy images, further alleviating the insufficiency of training data. The proposed framework is extensively evaluated on ISBI 2016 Skin Lesion Analysis Towards Melanoma Detection Challenge dataset. Experimental results demonstrate the significant performance gains of the proposed framework, ranking the first in classification and the second in segmentation among 25 teams and 28 teams, respectively. This study corroborates that very deep CNNs with effective training mechanisms can be employed to solve complicated medical image analysis tasks, even with limited training data. Our objective is to evaluate the efficacy of methods that use deep learning (DL) for the automatic fine-grained segmentation of optical coherence tomography (OCT) images of the retina. OCT images from 10 patients with mild non-proliferative diabetic retinopathy were used from a public (U. of Miami) dataset. For each patient, five images were available: one image of the fovea center, two images of the perifovea, and two images of the parafovea. For each image, two expert graders each manually annotated five retinal surfaces (i.e. boundaries between pairs of retinal layers). The first grader's annotations were used as ground truth and the second grader's annotations to compute inter-operator agreement. The proposed automated approach segments images using fully convolutional networks (FCNs) together with Gaussian process (GP)-based regression as a post-processing step to improve the quality of the estimates. Using 10-fold cross validation, the performance of the algorithms is determined by computing the per-pixel unsigned error (distance) between the automated estimates and the ground truth annotations generated by the first manual grader. We compare the proposed method against five state of the art automatic segmentation techniques. The results show that the proposed methods compare favorably with state of the art techniques, resulting in the smallest mean unsigned error values and associated standard deviations, and performance is comparable with human annotation of retinal layers from OCT when there is only mild retinopathy. The results suggest that semantic segmentation using FCNs, coupled with regression-based post-processing, can effectively solve the OCT segmentation problem on par with human capabilities with mild retinopathy. Early identification of diabetic foot complications and their precursors is essential in preventing their devastating consequences, such as foot infection and amputation. Frequent, automatic risk assessment by an intelligent telemedicine system might be feasible and cost effective. Infrared thermography is a promising modality for such a system. The temperature differences between corresponding areas on contralateral feet are the clinically significant parameters. This asymmetric analysis is hindered by (1) foot segmentation errors, especially when the foot temperature and the ambient temperature are comparable, and by (2) different shapes and sizes between contralateral feet due to deformities or minor amputations. To circumvent the first problem, we used a color image and a thermal image acquired synchronously. Foot regions, detected in the color image, were rigidly registered to the thermal image. This resulted in 97.8 ±1.1 sensitivity and 98.4 ±0.5 specificity over 76 high-risk diabetic patients with manual annotation as a reference. Nonrigid landmark-based registration with B-splines solved the second problem. Corresponding points in the two feet could be found regardless of the shapes and sizes of the feet. With that, the temperature difference of the left and right feet could be obtained.