Using Artificial Intelligence for COVID-19 Chest X-ray Diagnosis

Andrew A Borkowski; Narayan A Viswanadhan; L Brannon Thomas; Rodney D Guzman; Lauren A Deland; Stephen M Mastorides

doi:10.12788/fp.0045

Using Artificial Intelligence for COVID-19 Chest X-ray Diagnosis

Fed Pract. 2020 Sep;37(9):398-404. doi: 10.12788/fp.0045.

Authors

Andrew A Borkowski¹, Narayan A Viswanadhan¹, L Brannon Thomas¹, Rodney D Guzman¹, Lauren A Deland¹, Stephen M Mastorides¹

Affiliation

¹ is Chief of the Molecular Diagnostics Laboratory, is Chief of the Microbiology Laboratory, is a Research Coordinator, and is Chief of Pathology; is Assistant Chief of Radiology; all at the James A. Haley Veterans' Hospital in Tampa, Florida. is a Cofounder of InterKnowlogy, LLC in Carlsbad, California. Andrew Borkowski and Stephen Mastorides are Professors and L. Brannon Thomas is an Assistant Professor, all in the Department of Pathology and Cell Biology, University of South Florida, Morsani College of Medicine in Tampa, Florida.

Abstract

Background: Coronavirus disease-19 (COVID-19), caused by a novel member of the coronavirus family, is a respiratory disease that rapidly reached pandemic proportions with high morbidity and mortality. In only a few months, it has had a dramatic impact on society and world economies. COVID-19 has presented numerous challenges to all aspects of health care, including reliable methods for diagnosis, treatment, and prevention. Initial efforts to contain the spread of the virus were hampered by the time required to develop reliable diagnostic methods. Artificial intelligence (AI) is a rapidly growing field of computer science with many applications for health care. Machine learning is a subset of AI that uses deep learning with neural network algorithms. It can recognize patterns and achieve complex computational tasks often far quicker and with increased precision than can humans.

Methods: In this article, we explore the potential for the simple and widely available chest X-ray (CXR) to be used with AI to diagnose COVID-19 reliably. Microsoft CustomVision is an automated image classification and object detection system that is a part of Microsoft Azure Cognitive Services. We utilized publicly available CXR images for patients with COVID-19 pneumonia, pneumonia from other etiologies, and normal CXRs as a dataset to train Microsoft CustomVision.

Results: Our trained model overall demonstrated 92.9% sensitivity (recall) and positive predictive value (precision), with results for each label showing sensitivity and positive predictive value at 94.8% and 98.9% for COVID-19 pneumonia, 89% and 91.8% for non-COVID-19 pneumonia, 95% and 88.8% for normal lung. We then validated the program using CXRs of patients from our institution with confirmed COVID-19 diagnoses along with non-COVID-19 pneumonia and normal CXRs. Our model performed with 100% sensitivity, 95% specificity, 97% accuracy, 91% positive predictive value, and 100% negative predictive value.

Conclusions: We have used a readily available, commercial platform to demonstrate the potential of AI to assist in the successful diagnosis of COVID-19 pneumonia on CXR images. The findings have implications for screening and triage, initial diagnosis, monitoring disease progression, and identifying patients at increased risk of morbidity and mortality. Based on the data, a website was created to demonstrate how such technologies could be shared and distributed to others to combat entities such as COVID-19 moving forward.