Automated system for diagnosing pulmonary fibrosis using crackle analysis in recorded lung sounds based on iterative envelope mean fractal dimension filter

Abstract

Objective: patients with pulmonary fibrosis (PF) often experience long waits before getting a correct diagnosis, and this delay in reaching specialized care is associated with increased mortality, regardless of the severity of the disease. Early diagnosis and timely treatment of PF can potentially extend life expectancy and maintain a better quality of life. Crackles present in the recorded lung sounds may be crucial for the early diagnosis of PF.

Approach: this paper describes an automated system for differentiating lung sounds related to PF from other pathological lung conditions using the average number of crackles per breath cycle (NOC/BC). The system is divided into four main parts: (1) pre-processing, (2) separation of crackles from normal breath sounds using the iterative envelope mean fractal dimension filter, (3) crackle verification and counting, and (4) estimating NOC/BC. The system was tested on a dataset consisting of 48 (24 fibrotic and 24 non-fibrotic) subjects and the results were compared with an assessment by two expert respiratory physicians. The set of high-resolution computed tomography images, reviewed by two expert radiologists for the presence or absence of PF, was used as the ground truth for evaluating the PF and non-PF classification performance of the system.

Main results: the overall performance of the automatic classifier based on receiver operating curve-derived cut-off value for average NOC/BC of 18.65 (AUC = 0.845, 95% CI 0.739–0.952, p < 0.001; sensitivity = 91.7%; specificity = 59.3%) compares favourably with the averaged performance of the physicians (sensitivity = 83.3%; specificity = 56.25%).

Significance: although radiological assessment should remain the gold standard for diagnosis of fibrotic interstitial lung disease (ILD), the automatic classification system has strong potential for diagnostic support, especially in assisting general practitioners in the auscultatory assessment of lung sounds to prompt further diagnostic work up of patients with suspect of ILD.

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Identifiers

ORCID for Anna Barney: orcid.org/0000-0002-6034-1478

ORCID for Sophie Fletcher: orcid.org/0000-0002-5633-905X

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