Human interaction has become almost mandatory for an automated medical system wishing to be accepted by clinical regulatory agencies such as Food and Drug Administration. Since this interaction causes variability in the gathered data, the inter-observer and intra-observer variability must be analyzed in order to validate the accuracy of the system. This study focuses on the variability from different observers that interact with an automated lung delineation system that relies on human interaction in the form of delineation of the lung borders. The database consists of High Resolution Computed Tomography (HRCT): 15 normal and 81 diseased patients' images taken retrospectively at five levels per patient. Three observers manually delineated the lungs borders independently and using software called ImgTracer™ (AtheroPoint™, Roseville, CA, USA) to delineate the lung boundaries in all five levels of 3-D lung volume. The three observers consisted of Observer-1: lesser experienced novice tracer who is a resident in radiology under the guidance of radiologist, whereas Observer-2 and Observer-3 are lung image scientists trained by lung radiologist and biomedical imaging scientist and experts. The inter-observer variability can be shown by comparing each observer's tracings to the automated delineation and also by comparing each manual tracing of the observers with one another. The normality of the tracings was tested using D'Agostino-Pearson test and all observers tracings showed a normal P-value higher than 0.05. The analysis of variance (ANOVA) test between three observers and automated showed a P-value higher than 0.89 and 0.81 for the right lung (RL) and left lung (LL), respectively. The performance of the automated system was evaluated using Dice Similarity Coefficient (DSC), Jaccard Index (JI) and Hausdorff (HD) Distance measures. Although, Observer-1 has lesser experience compared to Obsever-2 and Obsever-3, the Observer Deterioration Factor (ODF) shows that Observer-1 has less than 10% difference compared to the other two, which is under acceptable range as per our analysis. To compare between observers, this study used regression plots, Bland-Altman plots, two tailed T-test, Mann-Whiney, Chi-Squared tests which showed the following P-values for RL and LL: (i) Observer-1 and Observer-3 were: 0.55, 0.48, 0.29 for RL and 0.55, 0.59, 0.29 for LL; (ii) Observer-1 and Observer-2 were: 0.57, 0.50, 0.29 for RL and 0.54, 0.59, 0.29 for LL; (iii) Observer-2 and Observer-3 were: 0.98, 0.99, 0.29 for RL and 0.99, 0.99, 0.29 for LL. Further, CC and R-squared coefficients were computed between observers which came out to be 0.9 for RL and LL. All three observers however manage to show the feature that diseased lungs are smaller than normal lungs in terms of area.
Voice disorders are associated with irregular vibrations of vocal folds. Based on the source filter theory of speech production, these irregular vibrations can be detected in a non-invasive way by analyzing the speech signal. In this paper we present a multiband approach for the detection of voice disorders given that the voice source generally interacts with the vocal tract in a non-linear way. In normal phonation, and assuming sustained phonation of a vowel, the lower frequencies of speech are heavily source dependent due to the low frequency glottal formant, while the higher frequencies are less dependent on the source signal. During abnormal phonation, this is still a valid, but turbulent noise of source, because of the irregular vibration, affects also higher frequencies. Motivated by such a model, we suggest a multiband approach based on a three-level discrete wavelet transformation (DWT) and in each band the fractal dimension (FD) of the estimated power spectrum is estimated. The experiments suggest that frequency band 1-1562 Hz, lower frequencies after level 3, exhibits a significant difference in the spectrum of a normal and pathological subject. With this band, a detection rate of 91.28 % is obtained with one feature, and the obtained result is higher than all other frequency bands. Moreover, an accuracy of 92.45 % and an area under receiver operating characteristic curve (AUC) of 95.06 % is acquired when the FD of all levels is fused. Likewise, when the FD of all levels is combined with 22 Multi-Dimensional Voice Program (MDVP) parameters, an improvement of 2.26 % in accuracy and 1.45 % in AUC is observed.
The main obstacles in mass adoption of cloud computing for database operations in healthcare organization are the data security and privacy issues. In this paper, it is shown that IT services particularly in hardware performance evaluation in virtual machine can be accomplished effectively without IT personnel gaining access to actual data for diagnostic and remediation purposes. The proposed mechanisms utilized the hypothetical data from TPC-H benchmark, to achieve 2 objectives. First, the underlying hardware performance and consistency is monitored via a control system, which is constructed using TPC-H queries. Second, the mechanism to construct stress-testing scenario is envisaged in the host, using a single or combination of TPC-H queries, so that the resource threshold point can be verified, if the virtual machine is still capable of serving critical transactions at this constraining juncture. This threshold point uses server run queue size as input parameter, and it serves 2 purposes: It provides the boundary threshold to the control system, so that periodic learning of the synthetic data sets for performance evaluation does not reach the host's constraint level. Secondly, when the host undergoes hardware change, stress-testing scenarios are simulated in the host by loading up to this resource threshold level, for subsequent response time verification from real and critical transactions.
An improved genetic algorithm procedure is introduced in this work based on the theory of the most highly fit parents (both male and female) are most likely to produce healthiest offspring. It avoids the destruction of near optimal information and promotes further search around the potential region by encouraging the exchange of highly important information among the fittest solution. A novel crossover technique called Segmented Multi-chromosome Crossover is also introduced. It maintains the information contained in gene segments and allows offspring to inherit information from multiple parent chromosomes. The improved GA is applied for the automatic and simultaneous parameter optimization and feature selection of multi-layer perceptron network in medical disease diagnosis. Compared to the previous works, the average accuracy of the proposed algorithm is the best among all algorithms for diabetes and heart dataset, and the second best for cancer dataset.
An improved and efficient method is presented in this paper to achieve a better trade-off between noise removal and edge preservation, thereby detecting the tumor region of MRI brain images automatically. Compass operator has been used in the fourth order Partial Differential Equation (PDE) based denoising technique to preserve the anatomically significant information at the edges. A new morphological technique is also introduced for stripping skull region from the brain images, which consequently leading to the process of detecting tumor accurately. Finally, automatic seeded region growing segmentation based on an improved single seed point selection algorithm is applied to detect the tumor. The method is tested on publicly available MRI brain images and it gives an average PSNR (Peak Signal to Noise Ratio) of 36.49. The obtained results also show detection accuracy of 99.46%, which is a significant improvement than that of the existing results.
Cardiovascular disease (CVD) is the major cause of death globally. More people die of CVDs each year than from any other disease. Over 80% of CVD deaths occur in low and middle income countries and occur almost equally in male and female. In this paper, different computational models based on Bayesian Networks, Multilayer Perceptron,Radial Basis Function and Logistic Regression methods are presented to predict early risk detection of the cardiovascular event. A total of 929 (626 male and 303 female) heart attack data are used to construct the models.The models are tested using combined as well as separate male and female data. Among the models used, it is found that the Multilayer Perceptron model yields the best accuracy result.
A significant proportion of the worldwide population is of the elderly people living with chronic diseases that result in high health-care cost. To provide continuous health monitoring with minimal health-care cost, Wireless Body Sensor Networks (WBSNs) has been recently emerged as a promising technology. Depending on nature of sensory data, WBSNs might require a high level of Quality of Service (QoS) both in terms of delay and reliability during data reporting phase. In this paper, we propose a data-centric routing for intra WBSNs that adapts the routing strategy in accordance with the nature of data, temperature rise issue of the implanted bio-medical sensors due to electromagnetic wave absorption, and high and dynamic path loss caused by postural movement of human body and in-body wireless communication. We consider the network models both with and without relay nodes in our simulations. Due to the multi-facet routing strategy, the proposed data-centric routing achieves better performance in terms of delay, reliability, temperature rise, and energy consumption when compared with other state-of-the-art.
The aim of this study was to explore the importance of service need along with perceived technology attributes in potentially influence the acceptance of teleconsultation. The study was conducted based on the concurrent triangulation design involving qualitative and quantitative study methods. These entailed interviews with key informants and questionnaires survey of health care providers who practiced in the participating hospitals in Malaysia. Thematic analysis involving iterative coding was conducted on qualitative data. Scale reliability test and hypothesis testing procedures were performed on quantitative data. Subsequently, both data were merged, compared and interpreted. In particular, this study utilized a qualitative priority such that a superior emphasis was placed on the qualitative method to demonstrate an overall understanding. Based on the responses of 20 key informants, there was a significant need for teleconsultation as a tool to extend health services to patients under constrained resources and critical conditions. Apparently, the latest attributes of teleconsultation technology have generally met users' expectation but rather perceived as supportive facets in encouraging the usage. Concurrently, based on the survey engaging 72 health care providers, teleconsultation acceptance was statistically proven to be strongly associated with service need and not originated exclusively from the technological attributes. Additionally, the results of this study can be used to promote teleconsultation as an effective means in delivering better health services. Thus, the categories emerged from this study may be further revised and examined for explaining the acceptance of teleconsultation technology in other relevant contexts.
In the present paper, a fuzzy rule-based system (FRBS) is designed to serve as a decision support system for Coronary heart disease (CHD) diagnosis that not only considers the decision accuracy of the rules but also their transparency at the same time. To achieve the two above mentioned objectives, we apply a multi-objective genetic algorithm to optimize both the accuracy and transparency of the FRBS. In addition and to help assess the certainty and the importance of each rule by the physician, an extended format of fuzzy rules that incorporates the degree of decision certainty and importance or support of each rule at the consequent part of the rules is introduced. Furthermore, a new way for employing Ensemble Classifiers Strategy (ECS) method is proposed to enhance the classification ability of the FRBS. The results show that the generated rules are humanly understandable while their accuracy compared favorably with other benchmark classification methods. In addition, the produced FRBS is able to identify the uncertainty cases so that the physician can give a special consideration to deal with them and this will result in a better management of efforts and tasks. Furthermore, employing ECS has specifically improved the ability of FRBS to detect patients with CHD which is desirable feature for any CHD diagnosis system.
The goal of this paper is to discuss and compare three feature extraction methods: Linear Predictive Coefficients (LPC), Linear Prediction Cepstral Coefficients (LPCC) and Weighted Linear Prediction Cepstral Coefficients (WLPCC) for recognizing the stuttered events. Speech samples from the University College London Archive of Stuttered Speech (UCLASS) were used for our analysis. The stuttered events were identified through manual segmentation and were used for feature extraction. Two simple classifiers namely, k-nearest neighbour (kNN) and Linear Discriminant Analysis (LDA) were employed for speech dysfluencies classification. Conventional validation method was used for testing the reliability of the classifier results. The study on the effect of different frame length, percentage of overlapping, value of ã in a first order pre-emphasizer and different order p were discussed. The speech dysfluencies classification accuracy was found to be improved by applying statistical normalization before feature extraction. The experimental investigation elucidated LPC, LPCC and WLPCC features can be used for identifying the stuttered events and WLPCC features slightly outperforms LPCC features and LPC features.
Studies related to healthcare ICT integration in Malaysia are relatively little, thus this paper provide a literature review of the integration of information and communication technologies (ICT) in the healthcare sector in Malaysia through the hospital information system (HIS). Our study emphasized on secondary data to investigate the factors related to ICT integration in healthcare through HIS. Therefore this paper aimed to gather an in depth understanding of issues related to HIS adoption, and contributing in fostering HIS adoption in Malaysia and other countries. This paper provides a direction for future research to study the correlation of factors affecting HIS adoption. Finally a research model is proposed using current adoption theories and external factors from human, technology, and organization perspectives.
Developing tools to assist physically disabled and immobilized people through facial expression is a challenging area of research and has attracted many researchers recently. In this paper, luminance stickers based facial expression recognition is proposed. Recognition of facial expression is carried out by employing Discrete Wavelet Transform (DWT) as a feature extraction method. Different wavelet families with their different orders (db1 to db20, Coif1 to Coif 5 and Sym2 to Sym8) are utilized to investigate their performance in recognizing facial expression and to evaluate their computational time. Standard deviation is computed for the coefficients of first level of wavelet decomposition for every order of wavelet family. This standard deviation is used to form a set of feature vectors for classification. In this study, conventional validation and cross validation are performed to evaluate the efficiency of the suggested feature vectors. Three different classifiers namely Artificial Neural Network (ANN), k-Nearest Neighborhood (kNN) and Linear Discriminant Analysis (LDA) are used to classify a set of eight facial expressions. The experimental results demonstrate that the proposed method gives very promising classification accuracies.
An important preliminary step in the diagnosis of leukemia is the visual examination of the patient's peripheral blood smear under the microscope. Morphological changes in the white blood cells can be an indicator of the nature and severity of the disease. Manual techniques are labor intensive, slow, error prone and costly. A computerized system can be used as a supportive tool for the specialist in order to enhance and accelerate the morphological analysis process. This research present a new method that integrates color features with the morphological reconstruction to localize and isolate lymphoblast cells from a microscope image that contains many cells. The localization and segmentation are conducted using a proposed method that consists of an integration of several digital image processing techniques. 180 microscopic blood images were tested, and the proposed framework managed to obtain 100% accuracy for the localization of the lymphoblast cells and separate it from the image scene. The results obtained indicate that the proposed method can be safely used for the purpose of lymphoblast cells localization and segmentation and subsequently, aiding the diagnosis of leukemia.
This paper presents a new approach to detect exudates and optic disc from color fundus images based on inverse surface thresholding. The strategy involves the applications of fuzzy c-means clustering, edge detection, otsu thresholding and inverse surface thresholding. The main advantage of the proposed approach is that it does not depend on manually selected parameters that are normally chosen to suit the tested databases. When applied to two sets of databases the proposed method outperforms a method based on watershed segmentation.
Acoustic analysis of infant cry signals has been proven to be an excellent tool in the area of automatic detection of pathological status of an infant. This paper investigates the application of parameter weighting for linear prediction cepstral coefficients (LPCCs) to provide the robust representation of infant cry signals. Three classes of infant cry signals were considered such as normal cry signals, cry signals from deaf babies and babies with asphyxia. A Probabilistic Neural Network (PNN) is suggested to classify the infant cry signals into normal and pathological cries. PNN is trained with different spread factor or smoothing parameter to obtain better classification accuracy. The experimental results demonstrate that the suggested features and classification algorithms give very promising classification accuracy of above 98% and it expounds that the suggested method can be used to help medical professionals for diagnosing pathological status of an infant from cry signals.
With the dramatic increase of the worldwide threat of dengue disease, it has been very crucial to correctly diagnose the dengue patients in order to decrease the disease severity. However, it has been a great challenge for the physicians to identify the level of risk in dengue patients due to overlapping of the medical classification criteria. Therefore, this study aims to construct a noninvasive diagnostic system to assist the physicians for classifying the risk in dengue patients. Systematic producers have been followed to develop the system. Firstly, the assessment of the significant predictors associated with the level of risk in dengue patients was carried out utilizing the statistical analyses technique. Secondly, Multilayer perceptron neural network models trained via Levenberg-Marquardt and Scaled Conjugate Gradient algorithms was employed for constructing the diagnostic system. Finally, precise tuning for the models' parameters was conducted in order to achieve the optimal performance. As a result, 9 noninvasive predictors were found to be significantly associated with the level of risk in dengue patients. By employing those predictors, 75% prediction accuracy has been achieved for classifying the risk in dengue patients using Scaled Conjugate Gradient algorithm while 70.7% prediction accuracy were achieved by using Levenberg-Marquardt algorithm.
The increasing number of diabetic retinopathy (DR) cases world wide demands the development of an automated decision support system for quick and cost-effective screening of DR. We present an automatic screening system for detecting the early stage of DR, which is known as non-proliferative diabetic retinopathy (NPDR). The proposed system involves processing of fundus images for extraction of abnormal signs, such as hard exudates, cotton wool spots, and large plaque of hard exudates. A rule based classifier is used for classifying the DR into two classes, namely, normal and abnormal. The abnormal NPDR is further classified into three levels, namely, mild, moderate, and severe. To evaluate the performance of the proposed decision support framework, the algorithms have been tested on the images of STARE database. The results obtained from this study show that the proposed system can detect the bright lesions with an average accuracy of about 97%. The study further shows promising results in classifying the bright lesions correctly according to NPDR severity levels.
Content-based image retrieval techniques have been extensively studied for the past few years. With the growth of digital medical image databases, the demand for content-based analysis and retrieval tools has been increasing remarkably. Blood cell image is a key diagnostic tool for hematologists. An automated system that can retrieved relevant blood cell images correctly and efficiently would save the effort and time of hematologists. The purpose of this work is to develop such a content-based image retrieval system. Global color histogram and wavelet-based methods are used in the prototype. The system allows users to search by providing a query image and select one of four implemented methods. The obtained results demonstrate the proposed extended query refinement has the potential to capture a user's high level query and perception subjectivity by dynamically giving better query combinations. Color-based methods performed better than wavelet-based methods with regard to precision, recall rate and retrieval time. Shape and density of blood cells are suggested as measurements for future improvement. The system developed is useful for undergraduate education.
This paper presents the results obtained for medical image compression using autoencoder neural networks. Since mammograms (medical images) are usually of big sizes, training of autoencoders becomes extremely tedious and difficult if the whole image is used for training. We show in this paper that the autoencoders can be trained successfully by using image patches instead of the whole image. The compression performances of different types of autoencoders are compared based on two parameters, namely mean square error and structural similarity index. It is found from the experimental results that the autoencoder which does not use Restricted Boltzmann Machine pre-training yields better results than those which use this pre-training method.