CIRCA: comprehensible online system in support of chest X-rays-based COVID-19 diagnosis

Due to the large accumulation of patients requiring hospitalization, the COVID-19 pandemic disease caused a high overload of health systems, even in developed countries. Deep learning techniques based on medical imaging data can help in the faster detection of COVID-19 cases and monitoring of disease progression. Regardless of the numerous proposed solutions for lung X-rays, none of them is a product that can be used in the clinic. Five different datasets (POLCOVID, AIforCOVID, COVIDx, NIH, and artificially generated data) were used to construct a representative dataset of 23 799 CXRs for model training; 1 050 images were used as a hold-out test set, and 44 247 as independent test set (BIMCV database). A U-Net-based model was developed to identify a clinically relevant region of the CXR. Each image class (normal, pneumonia, and COVID-19) was divided into 3 subtypes using a 2D Gaussian mixture model. A decision tree was used to aggregate predictions from the InceptionV3 network based on processed CXRs and a dense neural network on radiomic features. The lung segmentation model gave the Sorensen-Dice coefficient of 94.86% in the validation dataset, and 93.36% in the testing dataset. In 5-fold cross-validation, the accuracy for all classes ranged from 91% to 93%, keeping slightly higher specificity than sensitivity and NPV than PPV. In the hold-out test set, the balanced accuracy ranged between 68% and 100%. The highest performance was obtained for the subtypes N1, P1, and C1. A similar performance was obtained on the independent dataset for normal and COVID-19 class subtypes. Seventy-six percent of COVID-19 patients wrongly classified as normal cases were annotated by radiologists as with no signs of disease. Finally, we developed the online service (https://circa.aei.polsl.pl) to provide access to fast diagnosis support tools.