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. 2022 Dec 31;24(1):706.
doi: 10.3390/ijms24010706.

Effectiveness of Semi-Supervised Active Learning in Automated Wound Image Segmentation

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Effectiveness of Semi-Supervised Active Learning in Automated Wound Image Segmentation

Nico Curti et al. Int J Mol Sci. .

Abstract

Appropriate wound management shortens the healing times and reduces the management costs, benefiting the patient in physical terms and potentially reducing the healthcare system's economic burden. Among the instrumental measurement methods, the image analysis of a wound area is becoming one of the cornerstones of chronic ulcer management. Our study aim is to develop a solid AI method based on a convolutional neural network to segment the wounds efficiently to make the work of the physician more efficient, and subsequently, to lay the foundations for the further development of more in-depth analyses of ulcer characteristics. In this work, we introduce a fully automated model for identifying and segmenting wound areas which can completely automatize the clinical wound severity assessment starting from images acquired from smartphones. This method is based on an active semi-supervised learning training of a convolutional neural network model. In our work, we tested the robustness of our method against a wide range of natural images acquired in different light conditions and image expositions. We collected the images using an ad hoc developed app and saved them in a database which we then used for AI training. We then tested different CNN architectures to develop a balanced model, which we finally validated with a public dataset. We used a dataset of images acquired during clinical practice and built an annotated wound image dataset consisting of 1564 ulcer images from 474 patients. Only a small part of this large amount of data was manually annotated by experts (ground truth). A multi-step, active, semi-supervised training procedure was applied to improve the segmentation performances of the model. The developed training strategy mimics a continuous learning approach and provides a viable alternative for further medical applications. We tested the efficiency of our model against other public datasets, proving its robustness. The efficiency of the transfer learning showed that after less than 50 epochs, the model achieved a stable DSC that was greater than 0.95. The proposed active semi-supervised learning strategy could allow us to obtain an efficient segmentation method, thereby facilitating the work of the clinician by reducing their working times to achieve the measurements. Finally, the robustness of our pipeline confirms its possible usage in clinical practice as a reliable decision support system for clinicians.

Keywords: computer-aided diagnosis; deep learning; image analysis; image segmentation; wound healing.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Results obtained by the trained U-Net model at the 4th round of training. (a) Evolution of the average metrics (dice coefficient, precision, and recall) during the training epochs (150). The metric values are estimated on the test set, i.e., the 10% of available images, which were excluded from the training set. On the top left image is the resulting segmentation. (b) On the top right image is the predicted segmentation mask. On the bottom left image is the raw (input) image. On the bottom right image is the resulting ROI of the wound area.
Figure 2
Figure 2
Representation of the active semi-supervised learning strategy implemented for the training of the wound segmentation model. The images acquired using a smartphone were stored into the training dataset. Starting with a small set of annotated images (not included into the scheme), we trained from scratch a neural network model for the wound segmentation. All of the unlabeled images were used as validation set, and the generated masks were provided by the expert. The expert analyzed the produced segmentation according to a predetermined evaluation criterion. The masks which satisfied the criteria would be added as ground truth for the next round of training.

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Grants and funding

The authors received no specific funding for this work.

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