Lung segmentation constitutes a critical procedure for any clinical-decision supporting system aimed to improve the early diagnosis and treatment of lung diseases. Abnormal lungs mainly include lung parenchyma with commonalities on CT images across subjects, diseases and CT scanners, and lung lesions presenting various appearances. Segmentation of lung parenchyma can help locate and analyze the neighboring lesions, but is not well studied in the framework of machine learning. We proposed to segment lung parenchyma using a convolutional neural network (CNN) model. To reduce the workload of manually preparing the dataset for training the CNN, one clustering algorithm based method is proposed firstly. Specifically, after splitting CT slices into image patches, the k-means clustering algorithm with two categories is performed twice using the mean and minimum intensity of image patch, respectively. A cross-shaped verification, a volume intersection, a connected component analysis and a patch expansion are followed to generate final dataset. Secondly, we design a CNN architecture consisting of only one convolutional layer with six kernels, followed by one maximum pooling layer and two fully connected layers. Using the generated dataset, a variety of CNN models are trained and optimized, and their performances are evaluated by eightfold cross-validation. A separate validation experiment is further conducted using a dataset of 201 subjects (4.62 billion patches) with lung cancer or chronic obstructive pulmonary disease, scanned by CT or PET/CT. The segmentation results by our method are compared with those yielded by manual segmentation and some available methods. A total of 121,728 patches are generated to train and validate the CNN models. After the parameter optimization, our CNN model achieves an average F-score of 0.9917 and an area of curve up to 0.9991 for classification of lung parenchyma and non-lung-parenchyma. The obtain model can segment the lung parenchyma accurately for 201 subjects with heterogeneous lung diseases and CT scanners. The overlap ratio between the manual segmentation and the one by our method reaches 0.96. The results demonstrated that the proposed clustering algorithm based method can generate the training dataset for CNN models. The obtained CNN model can segment lung parenchyma with very satisfactory performance and have the potential to locate and analyze lung lesions.

Objective . Emphysema is characterized by the destruction and permanent enlargement of the alveoli in the lung. According to visual CT appearance, emphysema can be divided into three subtypes: centrilobular emphysema (CLE), panlobular emphysema (PLE), and paraseptal emphysema (PSE). Automating emphysema classification can help precisely determine the patterns of lung destruction and provide a quantitative evaluation. Approach . We propose a vision transformer (ViT) model to classify the emphysema subtypes via CT images. First, large patches (61 × 61) are cropped from CT images which contain the area of normal lung parenchyma, CLE, PLE, and PSE. After resizing, the large patch is divided into small patches and these small patches are converted to a sequence of patch embeddings by flattening and linear embedding. A class embedding is concatenated to the patch embedding, and the positional embedding is added to the resulting embeddings described above. Then, the obtained embedding is fed into the transformer encoder blocks to generate the final representation. Finally, the learnable class embedding is fed to a softmax layer to classify the emphysema. Main results . To overcome the lack of massive data, the transformer encoder blocks (pre-trained on ImageNet) are transferred and fine-tuned in our ViT model. The average accuracy of the pre-trained ViT model achieves 95.95% in our lab’s own dataset, which is higher than that of AlexNet, Inception-V3, MobileNet-V2, ResNet34, and ResNet50. Meanwhile, the pre-trained ViT model outperforms the ViT model without the pre-training. The accuracy of our pre-trained ViT model is higher than or comparable to that by available methods for the public dataset. Significance . The results demonstrated that the proposed ViT model can accurately classify the subtypes of emphysema using CT images. The ViT model can help make an effective computer-aided diagnosis of emphysema, and the ViT method can be extended to other medical applications.