Wound Tissue Segmentation in Diabetic Foot Ulcer Images Using Deep Learning: A Pilot Study

Identifying individual tissues, so-called tissue segmentation, in diabetic foot ulcer (DFU) images is a challenging task and little work has been published, largely due to the limited availability of a clinical image dataset. To address this gap, we have created a DFUTissue dataset for the research community to evaluate wound tissue segmentation algorithms. The dataset contains 110 images with tissues labeled by wound experts and 600 unlabeled images. Additionally, we conducted a pilot study on segmenting wound characteristics including fibrin, granulation, and callus using deep learning. Due to the limited amount of annotated data, our framework consists of both supervised learning (SL) and semi-supervised learning (SSL) phases. In the SL phase, we propose a hybrid model featuring a Mix Transformer (MiT-b3) in the encoder and a CNN in the decoder, enhanced by the integration of a parallel spatial and channel squeeze-and-excitation (P-scSE) module known for its efficacy in improving boundary accuracy. The SSL phase employs a pseudo-labeling-based approach, iteratively identifying and incorporating valuable unlabeled images to enhance overall segmentation performance. Comparative evaluations with state-of-the-art methods are conducted for both SL and SSL phases. The SL achieves a Dice Similarity Coefficient (DSC) of 84.89%, which has been improved to 87.64% in the SSL phase. Furthermore, the results are benchmarked against two widely used SSL approaches: Generative Adversarial Networks and Cross-Consistency Training. Additionally, our hybrid model outperforms the state-of-the-art methods with a 92.99% DSC in performing binary segmentation of DFU wound areas when tested on the Chronic Wound dataset. Codes and data are available at https://github.com/uwm-bigdata/DFUTissueSegNet.

Integrated Image and Location Analysis for Wound Classification: A Deep Learning Approach

The global burden of acute and chronic wounds presents a compelling case for enhancing wound classification methods, a vital step in diagnosing and determining optimal treatments. Recognizing this need, we introduce an innovative multi-modal network based on a deep convolutional neural network for categorizing wounds into four categories: diabetic, pressure, surgical, and venous ulcers. Our multi-modal network uses wound images and their corresponding body locations for more precise classification. A unique aspect of our methodology is incorporating a body map system that facilitates accurate wound location tagging, improving upon traditional wound image classification techniques. A distinctive feature of our approach is the integration of models such as VGG16, ResNet152, and EfficientNet within a novel architecture. This architecture includes elements like spatial and channel-wise Squeeze-and-Excitation modules, Axial Attention, and an Adaptive Gated Multi-Layer Perceptron, providing a robust foundation for classification. Our multi-modal network was trained and evaluated on two distinct datasets comprising relevant images and corresponding location information. Notably, our proposed network outperformed traditional methods, reaching an accuracy range of 74.79% to 100% for Region of Interest (ROI) without location classifications, 73.98% to 100% for ROI with location classifications, and 78.10% to 100% for whole image classifications. This marks a significant enhancement over previously reported performance metrics in the literature. Our results indicate the potential of our multi-modal network as an effective decision-support tool for wound image classification, paving the way for its application in various clinical contexts.

Wound Severity Classification using Deep Neural Network

The classification of wound severity is a critical step in wound diagnosis. An effective classifier can help wound professionals categorize wound conditions more quickly and affordably, allowing them to choose the best treatment option. This study used wound photos to construct a deep neural network-based wound severity classifier that classified them into one of three classes: green, yellow, or red. The green class denotes wounds still in the early stages of healing and are most likely to recover with adequate care. Wounds in the yellow category require more attention and treatment than those in the green category. Finally, the red class denotes the most severe wounds that require prompt attention and treatment. A dataset containing different types of wound images is designed with the help of wound specialists. Nine deep learning models are used with applying the concept of transfer learning. Several stacked models are also developed by concatenating these transfer learning models. The maximum accuracy achieved on multi-class classification is 68.49%. In addition, we achieved 78.79%, 81.40%, and 77.57% accuracies on green vs. yellow, green vs. red, and yellow vs. red classifications for binary classifications.

Machine learning techniques to identify antibiotic resistance in patients diagnosed with various skin and soft tissue infections

Skin and soft tissue infections (SSTIs) are among the most frequently observed diseases in ambulatory and hospital settings. Resistance of diverse bacterial pathogens to antibiotics is a significant cause of severe SSTIs, and treatment failure results in morbidity, mortality, and increased cost of hospitalization. Therefore, antimicrobial surveillance is essential to predict antibiotic resistance trends and monitor the results of medical interventions. To address this, we developed machine learning (ML) models (deep and conventional algorithms) to predict antimicrobial resistance using antibiotic susceptibility testing (ABST) data collected from patients clinically diagnosed with primary and secondary pyoderma over a period of one year. We trained an individual ML algorithm on each antimicrobial family to determine whether a Gram-Positive Cocci (GPC) or Gram-Negative Bacilli (GNB) bacteria will resist the corresponding antibiotic. For this purpose, clinical and demographic features from the patient and data from ABST were employed in training. We achieved an Area Under the Curve (AUC) of 0.68-0.98 in GPC and 0.56-0.93 in GNB bacteria, depending on the antimicrobial family. We also conducted a correlation analysis to determine the linear relationship between each feature and antimicrobial families in different bacteria. ML techniques suggest that a predictable nonlinear relationship exists between patients' clinical-demographic characteristics and antibiotic resistance; however, the accuracy of this prediction depends on the type of the antimicrobial family.

FUSeg: The Foot Ulcer Segmentation Challenge

Acute and chronic wounds with varying etiologies burden the healthcare systems economically. The advanced wound care market is estimated to reach $22 billion by 2024. Wound care professionals provide proper diagnosis and treatment with heavy reliance on images and image documentation. Segmentation of wound boundaries in images is a key component of the care and diagnosis protocol since it is important to estimate the area of the wound and provide quantitative measurement for the treatment. Unfortunately, this process is very time-consuming and requires a high level of expertise. Recently automatic wound segmentation methods based on deep learning have shown promising performance but require large datasets for training and it is unclear which methods perform better. To address these issues, we propose the Foot Ulcer Segmentation challenge (FUSeg) organized in conjunction with the 2021 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). We built a wound image dataset containing 1,210 foot ulcer images collected over 2 years from 889 patients. It is pixel-wise annotated by wound care experts and split into a training set with 1010 images and a testing set with 200 images for evaluation. Teams around the world developed automated methods to predict wound segmentations on the testing set of which annotations were kept private. The predictions were evaluated and ranked based on the average Dice coefficient. The FUSeg challenge remains an open challenge as a benchmark for wound segmentation after the conference.

Multi-modal Wound Classification using Wound Image and Location by Deep Neural Network

Wound classification is an essential step of wound diagnosis. An efficient classifier can assist wound specialists in classifying wound types with less financial and time costs and help them decide an optimal treatment procedure. This study developed a deep neural network-based multi-modal classifier using wound images and their corresponding locations to categorize wound images into multiple classes, including diabetic, pressure, surgical, and venous ulcers. A body map is also developed to prepare the location data, which can help wound specialists tag wound locations more efficiently. Three datasets containing images and their corresponding location information are designed with the help of wound specialists. The multi-modal network is developed by concatenating the image-based and location-based classifier's outputs with some other modifications. The maximum accuracy on mixed-class classifications (containing background and normal skin) varies from 77.33% to 100% on different experiments. The maximum accuracy on wound-class classifications (containing only diabetic, pressure, surgical, and venous) varies from 72.95% to 98.08% on different experiments. The proposed multi-modal network also shows a significant improvement in results from the previous works of literature.

Synthesizing time-series wound prognosis factors from electronic medical records using generative adversarial networks

Wound prognostic models not only provide an estimate of wound healing time to motivate patients to follow up their treatments but also can help clinicians to decide whether to use a standard care or adjuvant therapies and to assist them with designing clinical trials. However, collecting prognosis factors from Electronic Medical Records (EMR) of patients is challenging due to privacy, sensitivity, and confidentiality. In this study, we developed time series medical generative adversarial networks (GANs) to generate synthetic wound prognosis factors using very limited information collected during routine care in a specialized wound care facility. The generated prognosis variables are used in developing a predictive model for chronic wound healing trajectory. Our novel medical GAN can produce both continuous and categorical features from EMR. Moreover, we applied temporal information to our model by considering data collected from the weekly follow-ups of patients. Conditional training strategies were utilized to enhance training and generate classified data in terms of healing or non-healing. The ability of the proposed model to generate realistic EMR data was evaluated by TSTR (test on the synthetic, train on the real), discriminative accuracy, and visualization. We utilized samples generated by our proposed GAN in training a prognosis model to demonstrate its real-life application. Using the generated samples in training predictive models improved the classification accuracy by 6.66-10.01% compared to the previous EMR-GAN. Additionally, the suggested prognosis classifier has achieved the area under the curve (AUC) of 0.975, 0.968, and 0.849 when training the network using data from the first three visits, first two visits, and first visit, respectively. These results indicate a significant improvement in wound healing prediction compared to the previous prognosis models.

Multiclass Burn Wound Image Classification Using Deep Convolutional Neural Networks

Millions of people are affected by acute and chronic wounds yearly across the world. Continuous wound monitoring is important for wound specialists to allow more accurate diagnosis and optimization of management protocols. Machine Learning-based classification approaches provide optimal care strategies resulting in more reliable outcomes, cost savings, healing time reduction, and improved patient satisfaction. In this study, we use a deep learning-based method to classify burn wound images into two or three different categories based on the wound conditions. A pre-trained deep convolutional neural network, AlexNet, is fine-tuned using a burn wound image dataset and utilized as the classifier. The classifier's performance is evaluated using classification metrics such as accuracy, precision, and recall as well as confusion matrix. A comparison with previous works that used the same dataset showed that our designed classifier improved the classification accuracy by more than 8%.

Multiclass Wound Image Classification using an Ensemble Deep CNN-based Classifier

Acute and chronic wounds are a challenge to healthcare systems around the world and affect many people's lives annually. Wound classification is a key step in wound diagnosis that would help clinicians to identify an optimal treatment procedure. Hence, having a high-performance classifier assists the specialists in the field to classify the wounds with less financial and time costs. Different machine learning and deep learning-based wound classification methods have been proposed in the literature. In this study, we have developed an ensemble Deep Convolutional Neural Network-based classifier to classify wound images including surgical, diabetic, and venous ulcers, into multi-classes. The output classification scores of two classifiers (patch-wise and image-wise) are fed into a Multi-Layer Perceptron to provide a superior classification performance. A 5-fold cross-validation approach is used to evaluate the proposed method. We obtained maximum and average classification accuracy values of 96.4% and 94.28% for binary and 91.9\% and 87.7\% for 3-class classification problems. The results show that our proposed method can be used effectively as a decision support system in classification of wound images or other related clinical applications.

Fully Automatic Wound Segmentation with Deep Convolutional Neural Networks

Acute and chronic wounds have varying etiologies and are an economic burden to healthcare systems around the world. The advanced wound care market is expected to exceed $22 billion by 2024. Wound care professionals rely heavily on images and image documentation for proper diagnosis and treatment. Unfortunately lack of expertise can lead to improper diagnosis of wound etiology and inaccurate wound management and documentation. Fully automatic segmentation of wound areas in natural images is an important part of the diagnosis and care protocol since it is crucial to measure the area of the wound and provide quantitative parameters in the treatment. Various deep learning models have gained success in image analysis including semantic segmentation. Particularly, MobileNetV2 stands out among others due to its lightweight architecture and uncompromised performance. This manuscript proposes a novel convolutional framework based on MobileNetV2 and connected component labelling to segment wound regions from natural images. We build an annotated wound image dataset consisting of 1,109 foot ulcer images from 889 patients to train and test the deep learning models. We demonstrate the effectiveness and mobility of our method by conducting comprehensive experiments and analyses on various segmentation neural networks.