Deep Learning for Automated Echocardiogram Analysis
DOI:
https://doi.org/10.47611/jsrhs.v11i3.3085Keywords:
Deep learning, Machine Learning, Echocardiogram Analysis, Heart FailureAbstract
In the fight of heart disease (the #1 global killer), Left ventricular ejection fraction (EF) calculated via echocardiography plays crucial role for disease diagnosis and treatment because EF can distinguish heart failure from normal cardiac function. However, traditional EF calculation is a time-consuming manual process with high variability ‒ a single routine echocardiogram generates about 10–50 videos (~3,000 images), coupled with the limited capacity to analyze such large dataset by human experts often results in misdiagnosis. This project aimed to develop transparent and interpretable deep learning pipeline for automated echocardiogram analysis to calculate EF for quick assessment of cardiac function. Using the EchoNet dataset, five PyTorch deep learning models were trained to automatically calculate EF achieving mean error rates that ranged from 14-16%, comparable to that of expert cardiac sonographers, and significantly outperformed qualitative analysis by physicians (~30% error rate). Among the five models, MobileNet was identified as the best deep learning model for web application and portable devices; therefore, it was deployed as a web-based app through AWS, standalone PC, and Raspberry Pi, enabling upload and analyze echocardiogram videos and obtain EF calculation results within seconds. Such automated echocardiogram analysis can dramatically speed up image analysis, reduce the burden on cardiologists, eliminate inter-observer variability, hence democratize echocardiography by enabling non-experts to quickly and accurately assess cardiac functions at point of care even in cardiology expertise limited rural areas and developing countries. Future work includes improving these models with additional data and adapting the app for handheld ultrasound devices.
Downloads
References or Bibliography
CDC Heart Disease Facts: CDC Heart Disease Statistics and Maps, from https://www.cdc.gov/heartdisease/facts.htm
Cheitlin, M. D., Alpert, J. S., Armstrong, W. F., Aurigemma, G. P., Beller, G. A., Bierman, F. Z., Davidson, T. W., Davis, J. L., Douglas, P. S., & Gillam, L. D. (1997). ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation, 95(6), 1686-1744. doi:10.1161/01.cir.95.6.1686
Ulloa Cerna, A. E., Jing, L., Good, C. W., vanMaanen, D. P., Raghunath, S., Suever, J. D., Nevius, C. D., Wehner, G. J., Hartzel, D. N., Leader, J. B., Alsaid, A., Patel, A. A., Kirchner, H. L., Pfeifer, J. M., Carry, B. J., Pattichis, M. S., Haggerty, C. M., & Fornwalt, B. K. (2021). Deep-learning-assisted analysis of echocardiographic videos improves predictions of all-cause mortality. Nat Biomed Eng, 5(6), 546-554. doi:10.1038/s41551-020-00667-9
Jan, M. (2010) Impact of physician training on interpretation of echocardiograms and health care costs. in ASE 2010 Abstract P2-40 2010
St. Luke's review finds almost 30% echocardiograms are misread, from https://archive.jsonline.com/news/health/96945709.html/
Lin, S., Xie, M., Lv, Q., Wang, J., He, L., Wang, B., Li, Y., Xu, L., & Yang, Y. (2020). Misdiagnosis of anomalous origin of the left coronary artery from the pulmonary artery by echocardiography: Single-center experience from China. Echocardiography, 37(1), 104-113. doi:10.1111/echo.14578
Litjens, G., Kooi, T., Bejnordi, B. E., Setio, A., Ciompi, F., Ghafoorian, M., van der Laak, J., van Ginneken, B., & Sánchez, C. I. (2017). A survey on deep learning in medical image analysis. Med Image Anal, 42, 60-88. doi:10.1016/j.media.2017.07.005
Lang, R. M., MD, Badano, L. P., MD, & Mor-Avi, V., PhD. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults. JASE, 28(1), 1-53. Retrieved March 1, 2017, from http://asecho.org/wordpress/wp-content/uploads/2015/01/ChamberQuantification2015.pdf
Leclerc, S., Smistad, E., Pedrosa, J., Østvik, A., Cervenansky, F., Espinosa, F., Bernard, O. (2019). Deep Learning for Segmentation Using an Open Large-Scale Dataset in 2D Echocardiography. IEEE Transactions on Medical Imaging, 38(9), 2198-2210. doi:10.1109/TMI.2019.2900516
Ouyang, D., He, B., Ghorbani, A., Lungren, M. P., Ashley, E. A., Liang, D. H., & Zou, J. Y. (2019). EchoNet-Dynamic: a Large New Cardiac Motion Video Data Resource for Medical Machine Learning, from https://stanfordaimi.azurewebsites.net/datasets/834e1cd1-92f7-4268-9daa-d359198b310a
Ouyang, D., He, B., Ghorbani, A., Yuan, N., Ebinger, J., Langlotz, C. P., Zou, J. Y. (2020). Video-based AI for beat-to-beat assessment of cardiac function. Nature, 580(7802), 252-256. doi:10.1038/s41586-020-2145-8
Minaee, S., Boykov, Y. Y., Porikli, F., Plaza, A. J., Kehtarnavaz, N., & Terzopoulos, D. (2021). Image Segmentation Using Deep Learning: A Survey. IEEE Transactions on Pattern Analysis and Machine Intelligence, 1-1. doi:10.1109/TPAMI.2021.3059968
Pytorch Hub for Researchers, from https://pytorch.org/hub/research-models
The COCO-Stuff dataset, from https://github.com/nightrome/cocostuff
Zou, K. H., Warfield, S. K., Bharatha, A., Tempany, C. M., Kaus, M. R., Haker, S. J., Wells, W. M., 3rd, Jolesz, F. A., & Kikinis, R. (2004). Statistical validation of image segmentation quality based on a spatial overlap index. Acad Radiol, 11(2), 178-189. doi:10.1016/s1076-6332(03)00671-8
The Cardiac Cycle, from https://www.thoughtco.com/phases-of-the-cardiac-cycle-anatomy-373240
OpenCV, from https://opencv.org/
Cardiovacular Research & Training Center Cardiac Imaging Research Lab, from https://depts.washington.edu/cvrtc/simplvgm.html
Kosaraju, A., Goyal, A., Grigorova, Y., & Makaryus, A. N. (2022). Left Ventricular Ejection Fraction. StatPearls Publishing
Malm, S., Frigstad, S., Sagberg, E., Larsson, H., & Skjaerpe, T. (2004). Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. J Am Coll Cardiol, 44(5), 1030-1035. doi:10.1016/j.jacc.2004.05.068
Published
How to Cite
Issue
Section
Copyright (c) 2022 Samuel Wang; Dr. Ping Hu
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.