Chan Pang Kuok

Bio: Chan Pang Kuok is an academic researcher from National Cheng Kung University. The author has contributed to research in topics: Curvature & Cobb angle. The author has an hindex of 2, co-authored 2 publications receiving 54 citations.

Cobb Angle Measurement of Spine from X-Ray Images Using Convolutional Neural Network

Abstract: Scoliosis is a common spinal condition where the spine curves to the side and thus deforms the spine. Curvature estimation provides a powerful index to evaluate the deformation severity of scoliosis. In current clinical diagnosis, the standard curvature estimation method for assessing the curvature quantitatively is done by measuring the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebra involved and the lower endplate of the lowest vertebra involved. However, manual measurement of spine curvature requires considerable time and effort, along with associated problems such as interobserver and intraobserver variations. In this article, we propose an automatic system for measuring spine curvature using the anterior-posterior (AP) view spinal X-ray images. Due to the characteristic of AP view images, we first reduced the image size and then used horizontal and vertical intensity projection histograms to define the region of interest of the spine which is then cropped for sequential processing. Next, the boundaries of the spine, the central spinal curve line, and the spine foreground are detected by using intensity and gradient information of the region of interest, and a progressive thresholding approach is then employed to detect the locations of the vertebrae. In order to reduce the influences of inconsistent intensity distribution of vertebrae in the spine AP image, we applied the deep learning convolutional neural network (CNN) approaches which include the U-Net, the Dense U-Net, and Residual U-Net, to segment the vertebrae. Finally, the segmentation results of the vertebrae are reconstructed into a complete segmented spine image, and the spine curvature is calculated based on the Cobb angle criterion. In the experiments, we showed the results for spine segmentation and spine curvature; the results were then compared to manual measurements by specialists. The segmentation results of the Residual U-Net were superior to the other two convolutional neural networks. The one-way ANOVA test also demonstrated that the three measurements including the manual records of two different physicians and our proposed measured record were not significantly different in terms of spine curvature measurement. Looking forward, the proposed system can be applied in clinical diagnosis to assist doctors for a better understanding of scoliosis severity and for clinical treatments.

An effective and accurate identification system of Mycobacterium tuberculosis using convolution neural networks.

Abstract: Tuberculosis (TB) remains the leading cause of morbidity and mortality from infectious disease in developing countries. The sputum smear microscopy remains the primary diagnostic laboratory test. However, microscopic examination is always time-consuming and tedious. Therefore, an effective computer-aided image identification system is needed to provide timely assistance in diagnosis. The current identification system usually suffers from complex color variations of the images, resulting in plentiful of false object detection. To overcome the dilemma, we propose a two-stage Mycobacterium tuberculosis identification system, consisting of candidate detection and classification using convolution neural networks (CNNs). The refined Faster region-based CNN was used to distinguish candidates of M. tuberculosis and the actual ones were classified by utilizing CNN-based classifier. We first compared three different CNNs, including ensemble CNN, single-member CNN, and deep CNN. The experimental results showed that both ensemble and deep CNNs were on par with similar identification performance when analyzing more than 19,000 images. A much better recall value was achieved by using our proposed system in comparison with conventional pixel-based support vector machine method for M. tuberculosis bacilli detection.

The Development of a Skin Cancer Classification System for Pigmented Skin Lesions Using Deep Learning.

Abstract: Recent studies have demonstrated the usefulness of convolutional neural networks (CNNs) to classify images of melanoma, with accuracies comparable to those achieved by dermatologists. However, the performance of a CNN trained with only clinical images of a pigmented skin lesion in a clinical image classification task, in competition with dermatologists, has not been reported to date. In this study, we extracted 5846 clinical images of pigmented skin lesions from 3551 patients. Pigmented skin lesions included malignant tumors (malignant melanoma and basal cell carcinoma) and benign tumors (nevus, seborrhoeic keratosis, senile lentigo, and hematoma/hemangioma). We created the test dataset by randomly selecting 666 patients out of them and picking one image per patient, and created the training dataset by giving bounding-box annotations to the rest of the images (4732 images, 2885 patients). Subsequently, we trained a faster, region-based CNN (FRCNN) with the training dataset and checked the performance of the model on the test dataset. In addition, ten board-certified dermatologists (BCDs) and ten dermatologic trainees (TRNs) took the same tests, and we compared their diagnostic accuracy with FRCNN. For six-class classification, the accuracy of FRCNN was 86.2%, and that of the BCDs and TRNs was 79.5% (p = 0.0081) and 75.1% (p < 0.00001), respectively. For two-class classification (benign or malignant), the accuracy, sensitivity, and specificity were 91.5%, 83.3%, and 94.5% by FRCNN; 86.6%, 86.3%, and 86.6% by BCD; and 85.3%, 83.5%, and 85.9% by TRN, respectively. False positive rates and positive predictive values were 5.5% and 84.7% by FRCNN, 13.4% and 70.5% by BCD, and 14.1% and 68.5% by TRN, respectively. We compared the classification performance of FRCNN with 20 dermatologists. As a result, the classification accuracy of FRCNN was better than that of the dermatologists. In the future, we plan to implement this system in society and have it used by the general public, in order to improve the prognosis of skin cancer.

A Review on the Use of Artificial Intelligence in Spinal Diseases.

Abstract: Artificial neural networks (ANNs) have been used in a wide variety of real-world applications and it emerges as a promising field across various branches of medicine. This review aims to identify the role of ANNs in spinal diseases. Literature were searched from electronic databases of Scopus and Medline from 1993 to 2020 with English publications reported on the application of ANNs in spinal diseases. The search strategy was set as the combinations of the following keywords: "artificial neural networks," "spine," "back pain," "prognosis," "grading," "classification," "prediction," "segmentation," "biomechanics," "deep learning," and "imaging." The main findings of the included studies were summarized, with an emphasis on the recent advances in spinal diseases and its application in the diagnostic and prognostic procedures. According to the search strategy, a set of 3,653 articles were retrieved from Medline and Scopus databases. After careful evaluation of the abstracts, the full texts of 89 eligible papers were further examined, of which 79 articles satisfied the inclusion criteria of this review. Our review indicates several applications of ANNs in the management of spinal diseases including (1) diagnosis and assessment of spinal disease progression in the patients with low back pain, perioperative complications, and readmission rate following spine surgery; (2) enhancement of the clinically relevant information extracted from radiographic images to predict Pfirrmann grades, Modic changes, and spinal stenosis grades on magnetic resonance images automatically; (3) prediction of outcomes in lumbar spinal stenosis, lumbar disc herniation and patient-reported outcomes in lumbar fusion surgery, and preoperative planning and intraoperative assistance; and (4) its application in the biomechanical assessment of spinal diseases. The evidence suggests that ANNs can be successfully used for optimizing the diagnosis, prognosis and outcome prediction in spinal diseases. Therefore, incorporation of ANNs into spine clinical practice may improve clinical decision making.

A deep learning tool for fully automated measurements of sagittal spinopelvic balance from X-ray images: performance evaluation

Abstract: The purpose of this study is to evaluate the performance of a novel deep learning (DL) tool for fully automated measurements of the sagittal spinopelvic balance from X-ray images of the spine in comparison with manual measurements. Ninety-seven conventional upright sagittal X-ray images from 55 subjects were retrospectively included in this study. Measurements of the parameters of the sagittal spinopelvic balance, i.e., the sacral slope (SS), pelvic tilt (PT), spinal tilt (ST), pelvic incidence (PI) and spinosacral angle (SSA), were obtained manually by identifying specific anatomical landmarks using the SurgiMap Spine software and by the fully automated DL tool. Statistical analysis was performed in terms of the mean absolute difference (MAD), standard deviation (SD) and Pearson correlation, while the paired t test was used to search for statistically significant differences between manual and automated measurements. The differences between reference manual measurements and those obtained automatically by the DL tool were, respectively, for SS, PT, ST, PI and SSA, equal to 5.0° (3.4°), 2.7° (2.5°), 1.2° (1.2°), 5.5° (4.2°) and 5.0° (3.5°) in terms of MAD (SD), with a statistically significant corresponding Pearson correlation of 0.73, 0.90, 0.95, 0.81 and 0.71. No statistically significant differences were observed between the two types of measurement (p value always above 0.05). The differences between measurements are in the range of the observer variability of manual measurements, indicating that the DL tool can provide clinically equivalent measurements in terms of accuracy but superior measurements in terms of cost-effectiveness, reliability and reproducibility.

A Deep Learning Approach for Automatic Scoliosis Cobb Angle Identification

Abstract: Efficient and reliable medical image analysis is indispensable in modern healthcare settings. The conventional approaches in diagnostics and evaluations from a mere picture are complex. It often leads to subjectivity due to experts' various experiences and expertise. Using convolutional neural networks, we proposed an end-to-end pipeline for automatic Cobb angle measurement to pinpoint scoliosis severity. Our results show that the Residual U-Net architecture provides vertebrae average segmentation accuracy of 92.95% based on Dice and Jaccard similarity coefficients. Furthermore, a comparative benchmark between physician's measurement and our machine-driven approach produces an acceptable mean deviation of 1.57 degrees and a T-test p-value of 0.9028, indicating no significant difference. This study has the potential to help doctors in prompt scoliosis magnitude assessments.