Automatic foot ulcer segmentation using conditional generative adversarial network (AFSegGAN): A wound management system

Abstract

Effective wound care is essential to prevent further complications, promote healing, and reduce the risk of infection and other health issues. Chronic wounds, particularly in older adults, patients with disabilities, and those with pressure, venous, or diabetic foot ulcers, cause significant morbidity and mortality. Due to the positive trend in the number of individuals with chronic wounds, particularly among the growing elderly and diabetes populations, it is imperative to develop novel technologies and practices for the best practice clinical management of chronic wounds to minimize the potential health and economic burdens on society. As wound care is managed in hospitals and community care, it is crucial to have quantitative metrics like wound boundary and morphological features. The traditional visual inspection technique is purely subjective and error-prone, and digitization provides an appealing alternative. Various deep-learning models have earned confidence; however, their accuracy primarily relies on the image quality, the dataset size to learn the features, and experts’ annotation. This work aims to develop a wound management system that automates wound segmentation using a conditional generative adversarial network (cGAN) and estimate the wound morphological parameters. AFSegGAN was developed and validated on the MICCAI 2021-foot ulcer segmentation dataset. In addition, we use adversarial loss and patch-level comparison at the discriminator network to improve the segmentation performance and balance the GAN network training. Our model outperformed state-of-the-art methods with a Dice score of 93.11% and IoU of 99.07%. The proposed wound management system demonstrates its abilities in wound segmentation and parameter estimation, thereby reducing healthcare workers’ efforts to diagnose or manage wounds and facilitating remote healthcare.