Deep learning detection and quantification of pneumothorax in heterogeneous routine chest computed tomography

BACKGROUND: Automatically detecting and quantifying pneumothorax on chest computed tomography (CT) may impact clinical decision-making. Machine learning methods published so far struggle with the heterogeneity of technical parameters and the presence of additional pathologies, highlighting the importance of stable algorithms. METHODS: A deep residual UNet was developed and evaluated for automated, volume-level pneumothorax grading (i.e., labelling a volume whether a pneumothorax was present or not), and pixel-level classification (i.e., segmentation and quantification of pneumothorax), on a retrospective series of routine chest CT data. Ground truth annotations were provided by radiologists. The fully automated pixel-level pneumothorax segmentation method was trained using 43 chest CT scans and evaluated on 9 chest CT scans with pixel-level annotation basis and 567 chest CT scans on a volume-level basis. RESULTS: This method achieved a receiver operating characteristic area under the curve (AUC) of 0.98, an average precision of 0.97, and a Dice similarity coefficient (DSC) of 0.94. This segmentation performance resulted to be similar to the inter-rater segmentation accuracy of two radiologists, who achieved a DSC of 0.92. The comparison of manual and automated pneumothorax quantification yielded a Pearson correlation coefficient of 0.996. The volume-level pneumothorax grading accuracy was evaluated on 567 chest CT scans and yielded an AUC of 0.98 and an average precision of 0.95. CONCLUSIONS: We proposed a deep learning method for the detection and quantification of pneumothorax in heterogeneous routine clinical data that may facilitate the automated triage of urgent examinations and enable treatment decision support.