title: CIMIDx: Prototype for a Cloud-Based System to Support Intelligent Medical Image Diagnosis With Efficiency.
abstract: BACKGROUND
  The Internet has greatly enhanced health care, helping patients stay up-to-date on medical issues and general knowledge. Many cancer patients use the Internet for cancer diagnosis and related information. Recently, cloud computing has emerged as a new way of delivering health services but currently, there is no generic and fully automated cloud-based self-management intervention for breast cancer patients, as practical guidelines are lacking.
  
  
  OBJECTIVE
  We investigated the prevalence and predictors of cloud use for medical diagnosis among women with breast cancer to gain insight into meaningful usage parameters to evaluate the use of generic, fully automated cloud-based self-intervention, by assessing how breast cancer survivors use a generic self-management model. The goal of this study was implemented and evaluated with a new prototype called "CIMIDx", based on representative association rules that support the diagnosis of medical images (mammograms).
  
  
  METHODS
  The proposed Cloud-Based System Support Intelligent Medical Image Diagnosis (CIMIDx) prototype includes two modules. The first is the design and development of the CIMIDx training and test cloud services. Deployed in the cloud, the prototype can be used for diagnosis and screening mammography by assessing the cancers detected, tumor sizes, histology, and stage of classification accuracy. To analyze the prototype's classification accuracy, we conducted an experiment with data provided by clients. Second, by monitoring cloud server requests, the CIMIDx usage statistics were recorded for the cloud-based self-intervention groups. We conducted an evaluation of the CIMIDx cloud service usage, in which browsing functionalities were evaluated from the end-user's perspective.
  
  
  RESULTS
  We performed several experiments to validate the CIMIDx prototype for breast health issues. The first set of experiments evaluated the diagnostic performance of the CIMIDx framework. We collected medical information from 150 breast cancer survivors from hospitals and health centers. The CIMIDx prototype achieved high sensitivity of up to 99.29%, and accuracy of up to 98%. The second set of experiments evaluated CIMIDx use for breast health issues, using t tests and Pearson chi-square tests to assess differences, and binary logistic regression to estimate the odds ratio (OR) for the predictors' use of CIMIDx. For the prototype usage statistics for the same 150 breast cancer survivors, we interviewed 114 (76.0%), through self-report questionnaires from CIMIDx blogs. The frequency of log-ins/person ranged from 0 to 30, total duration/person from 0 to 1500 minutes (25 hours). The 114 participants continued logging in to all phases, resulting in an intervention adherence rate of 44.3% (95% CI 33.2-55.9). The overall performance of the prototype for the good category, reported usefulness of the prototype (P=.77), overall satisfaction of the prototype (P=.31), ease of navigation (P=.89), user friendliness evaluation (P=.31), and overall satisfaction (P=.31). Positive evaluations given by 100 participants via a Web-based questionnaire supported our hypothesis.
  
  
  CONCLUSIONS
  The present study shows that women felt favorably about the use of a generic fully automated cloud-based self- management prototype. The study also demonstrated that the CIMIDx prototype resulted in the detection of more cancers in screening and diagnosing patients, with an increased accuracy rate.
authors.affiliation: Department of Computer Science and Engineering, College of Engineering, Anna University, Chennai, Tamilnadu, India.
authors.forename: Selvaraj Rani
authors.identifier: http://orcid.org/0000-0002-2283-8125
authors.initials: SR
authors.lastname: Bhavani
authors.forename: Jagatheesan
authors.identifier: http://orcid.org/0000-0002-0026-1759
authors.initials: J
authors.lastname: Senthilkumar
authors.forename: Arul Gnanaprakasam
authors.identifier: http://orcid.org/0000-0002-6346-9645
authors.initials: AG
authors.lastname: Chilambuchelvan
authors.forename: Dhanabalachandran
authors.identifier: http://orcid.org/0000-0001-9442-6739
authors.initials: D
authors.lastname: Manjula
authors.forename: Ramasamy
authors.identifier: http://orcid.org/0000-0003-1823-5855
authors.initials: R
authors.lastname: Krishnamoorthy
authors.forename: Arputharaj
authors.identifier: http://orcid.org/0000-0002-3564-395X
authors.initials: A
authors.lastname: Kannan
keywords: SOAP; UDDI; Web-based intervention; association rules; breast cancer; cloud computing; feature extraction; intelligent system; medical diagnosis; pre-processing; segmentation
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