Dual-energy (DE) chest radiographs provide greater diagnostic information than standard radiographs by separating the image into bone and soft tissue, revealing suspicious lesions which may otherwise be obstructed from view. However, acquisition of DE images requires two physical scans, necessitating specialized hardware and processing, and images are prone to motion artifact. Generation of virtual DE images from standard, single-shot chest radiographs would expand the diagnostic value of standard radiographs without changing the acquisition procedure. We present a Multi-scale Conditional Adversarial Network (MCA-Net) which produces high-resolution virtual DE bone images from standard, single-shot chest radiographs. Our proposed MCA-Net is trained using the adversarial network so that it learns sharp details for the production of high-quality bone images. Then, the virtual DE soft tissue image is generated by processing the standard radiograph with the virtual bone image using a cross projection transformation. Experimental results from 210 patient DE chest radiographs demonstrated that the algorithm can produce high-quality virtual DE chest radiographs. Important structures were preserved, such as coronary calcium in bone images and lung lesions in soft tissue images. The average structure similarity index and the peak signal to noise ratio of the produced bone images in testing data were 96.4 and 41.5, which are significantly better than results from previous methods. Furthermore, our clinical evaluation results performed on the publicly available dataset indicates the clinical values of our algorithms. Thus, our algorithm can produce high-quality DE images that are potentially useful for radiologists, computer-aided diagnostics, and other diagnostic tasks.
Besides from the learning-based methods, several statistical analysis based methods for suppressing bone structures without the supervision from training data have been studied. @cite_1 proposed a clavicle suppression algorithm which works by first generating a bone image from a gradient map modified along the bone border direction and then creating a soft-tissue image by subtraction of the bone image from the standard image. Later, @cite_26 @cite_15 proposed blind-source signal separation algorithms for suppression of bone structures in standard chest radiography. @cite_22 presented a ribcage segmentation algorithm based on Active Appearance Model that can accurately estimate the rib border and suppress the bone signal from standard radiography based on this prediction. In general, these statistical based methods require accurate segmentation and border annotations for the target structures, which is challenging to acquire. Although all have shown improvement in thoracic disease detection, many image details are suppressed and these methods require substantial hyper-parameter tuning.
@cite_15 @cite_26 @cite_1 @cite_22
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Projection images, such as those routinely acquired in radiological practice, are difficult to analyze because multiple 3-D structures superimpose at a single point in the 2-D image. Removal of particular superimposed structures may improve interpretation of these images, both by humans and by computers. This work therefore presents a general method to isolate and suppress structures in 2-D projection images. The focus is on elongated structures, which allows an intensity model of a structure of interest to be extracted using local information only. The model is created from profiles sampled perpendicular to the structure. Profiles containing other structures are detected and removed to reduce the influence on the model. Subspace filtering, using blind source separation techniques, is applied to separate the structure to be suppressed from other structures. By subtracting the modeled structure from the original image a structure suppressed image is created. The method is evaluated in four experiments. In the first experiment ribs are suppressed in 20 artificial radiographs simulated from 3-D lung computed tomography (CT) images. The proposed method with blind source separation and outlier detection shows superior suppression of ribs in simulated radiographs, compared to a simplified approach without these techniques. Additionally, the ability of three observers to discriminate between patches containing ribs and containing no ribs, as measured by the area under the receiver operating characteristic curve (AUC), reduced from 0.99-1.00 on original images to 0.75-0.84 on suppressed images. In the second experiment clavicles are suppressed in 253 chest radiographs. The effect of suppression on clavicle visibility is evaluated using the clavicle contrast and border response, showing a reduction of 78 and 34 , respectively. In the third experiment nodules extracted from CT were simulated close to the clavicles in 100 chest radiographs. It was found that after suppression contrast of the nodules was higher than of the clavicles (1.35 and 0.55, respectively) than on original images (1.83 and 2.46, respectively). In the fourth experiment catheters were suppressed in chest radiographs. The ability of three observers to discriminate between patches originating from 36 images with and 21 images without catheters, as measured by the AUC, reduced from 0.98-0.99 on original images to 0.64-0.74 on suppressed images. We conclude that the presented method can markedly reduce the visibility of elongated structures in chest radiographs and shows potential to enhance diagnosis. Most lung nodules that are missed by radiologists as well as computer-aided detection (CADe) schemes overlap with ribs or clavicles in chest radiographs (CXRs). The purpose of this study was to separate bony structures such as ribs and clavicles from soft tissue in CXRs. To achieve this, we developed anatomically (location-) specific multiple massive-training artificial neural networks (MTANNs) which is a class of pixel-based machine learning combined with total variation (TV) minimization smoothing and a histogram-matching-based consistency processing technique. Multi-resolution MTANNs have previously been developed for rib suppression by use of input CXRs and the corresponding “teaching” images for training. Although they were able to suppress ribs, they did not suppress rib edges, ribs close to the lung wall, and the clavicles very well because the orientation, width, contrast, and density of bones are different from location to location and the capability of a single set of multi-resolution MTANNs is limited. To address this issue, the anatomically specific multiple MTANNs developed in this work were designed to separate bones from soft tissue in different anatomic segments of the lungs. Each of multiple anatomically specific MTANNs was trained with the corresponding anatomic segment in the teaching bone images. The output segmental images from the multiple MTANNs were merged to produce a whole bone image. Total variation minimization smoothing was applied to the bone image for reduction of noise while edges were preserved. This bone image was then subtracted from the original CXR to produce a soft-tissue image where the bones were separated out. In order to ensure the contrast and density in different segments were consistent, a histogram-matching technique was applied to the input segmental images. This new method was compared with the conventional MTANNs by using a database of 110 CXRs with pulmonary nodules. Our new anatomically (location-) specific MTANNs separated rib edges, ribs close to the lung wall, and the clavicles from soft tissue in CXRs to a substantially higher level than the conventional MTANNs did, while the visibility of lung nodules and vessels was maintained. Thus, our image-processing technique for bone-soft-tissue separation by means of our new anatomically specific multiple MTANNs would be potentially useful for radiologists as well as for CAD schemes in detection of lung nodules on CXRs. A novel framework for image filtering based on regression is presented. Regression is a supervised technique from pattern recognition theory in which a mapping from a number of input variables (features) to a continuous output variable is learned from a set of examples from which both input and output are known. We apply regression on a pixel level. A new, substantially different, image is estimated from an input image by computing a number of filtered input images (feature images) and mapping these to the desired output for every pixel in the image. The essential difference between conventional image filters and the proposed regression filter is that the latter filter is learned from training data. The total scheme consists of preprocessing, feature computation, feature extraction by a novel dimensionality reduction scheme designed specifically for regression, regression by k-nearest neighbor averaging, and (optionally) iterative application of the algorithm. The framework is applied to estimate the bone and soft-tissue components from standard frontal chest radiographs. As training material, radiographs with known soft-tissue and bone components, obtained by dual energy imaging, are used. The results show that good correlation with the true soft-tissue images can be obtained and that the scheme can be applied to images from a different source with good results. We show that bone structures are effectively enhanced and suppressed and that in most soft-tissue images local contrast of ribs decreases more than contrast between pulmonary nodules and their surrounding, making them relatively more pronounced. This paper considers the task of thorax disease classification on chest X-ray images. Existing methods generally use the global image as input for network learning. Such a strategy is limited in two aspects. 1) A thorax disease usually happens in (small) localized areas which are disease specific. Training CNNs using global image may be affected by the (excessive) irrelevant noisy areas. 2) Due to the poor alignment of some CXR images, the existence of irregular borders hinders the network performance. In this paper, we address the above problems by proposing a three-branch attention guided convolution neural network (AG-CNN). AG-CNN 1) learns from disease-specific regions to avoid noise and improve alignment, 2) also integrates a global branch to compensate the lost discriminative cues by local branch. Specifically, we first learn a global CNN branch using global images. Then, guided by the attention heat map generated from the global branch, we inference a mask to crop a discriminative region from the global image. The local region is used for training a local CNN branch. Lastly, we concatenate the last pooling layers of both the global and local branches for fine-tuning the fusion branch. The Comprehensive experiment is conducted on the ChestX-ray14 dataset. We first report a strong global baseline producing an average AUC of 0.841 with ResNet-50 as backbone. After combining the local cues with the global information, AG-CNN improves the average AUC to 0.868. While DenseNet-121 is used, the average AUC achieves 0.871, which is a new state of the art in the community.