Abstract--Background: Automated analysis of lung sound auscultation is essential for monitoring respiratory health, particularly in regions with a shortage of skilled healthcare workers. Although respiratory sound classification has been widely studied in adults, its application in pediatric populations, especially in children under six years of age remains underexplored. Developmental changes in pediatric lungs substantially modify the acoustic properties of respiratory sounds, requiring classification approaches tailored specifically to this age group. Methods: T o address this challenge, we propose a multistage hybrid CNN-Transformer framework that integrates CNN-extracted features with an attention-based architecture for pediatric respiratory disease classification. Scalogram images were generated from both full recordings and individual breath events to capture multi-resolution representations of respiratory sounds. T o mitigate class imbalance, class-wise focal loss was applied during model training. Results: The proposed model achieved an overall score of 0.9039 in binary event classification At the recording level, the model obtained scores of 0.720 for ternary classification and 0.571 for multiclass classification. These results outperform the previous best-performing models by 3.81% and 5.94%, respectively. Conclusion: Our findings demonstrate that the proposed hybrid CNN-Transformer framework effectively captures the unique acoustic features of pediatric lung sounds.

Large language models (LLMs) hold promise for addressing healthcare challenges but often generate hallucinations due to limited integration of medical knowledge. Incorporating external medical knowledge is therefore critical, especially considering the breadth and complexity of medical content, which necessitates effective multi-source knowledge acquisition. We address this challenge by framing it as a source planning problem, where the task is to formulate context-appropriate queries tailored to the attributes of diverse knowledge sources. Existing approaches either overlook source planning or fail to achieve it effectively due to misalignment between the model's expectation of the sources and their actual content. To bridge this gap, we present MedOmniKB, a comprehensive repository comprising multigenre and multi-structured medical knowledge sources. Leveraging these sources, we propose the Source Planning Optimisation (SPO) method, which enhances multi-source utilisation through explicit planning optimisation. Our approach involves enabling an expert model to explore and evaluate potential plans while training a smaller model to learn source alignment using positive and negative planning samples. Experimental results demonstrate that our method substantially improves multi-source planning performance, enabling the optimised small model to achieve state-of-the-art results in leveraging diverse medical knowledge sources.

Cardiac auscultation, an integral tool in diagnosing cardiovascular diseases (CVDs), often relies on the subjective interpretation of clinicians, presenting a limitation in consistency and accuracy. Addressing this, we introduce the BUET Multi-disease Heart Sound (BMD-HS) dataset - a comprehensive and meticulously curated collection of heart sound recordings. This dataset, encompassing 864 recordings across five distinct classes of common heart sounds, represents a broad spectrum of valvular heart diseases, with a focus on diagnostically challenging cases. The standout feature of the BMD-HS dataset is its innovative multi-label annotation system, which captures a diverse range of diseases and unique disease states. This system significantly enhances the dataset's utility for developing advanced machine learning models in automated heart sound classification and diagnosis. By bridging the gap between traditional auscultation practices and contemporary data-driven diagnostic methods, the BMD-HS dataset is poised to revolutionize CVD diagnosis and management, providing an invaluable resource for the advancement of cardiac health research. The dataset is publicly available at this link: https://github.com/mHealthBuet/BMD-HS-Dataset.

This paper presents a comprehensive review of cardiorespiratory auscultation sensing devices which is useful for understanding the theoretical aspects of sensing devices, as well as practical notes to design novel sensing devices. One of the methods to design a stethoscope is using electret condenser microphones (ECM). In this paper, we first introduce the acoustic properties of the heart and lungs, as well as a brief history of stethoscope evolution. Then, we discuss the basic concept of ECM sensors and a recent stethoscope based on this technology. In response to the limitations of ECM-based systems, we explore the potential of microelectromechanical systems (MEMS), particularly focusing on piezoelectric transducer (PZT) sensors. This paper comprehensively reviews sensing technologies, emphasizing innovative MEMS-based designs for wearable cardiopulmonary auscultation in the past decade. To our knowledge, this is the first paper to summarize ECM and MEMS applications for heart and lung sound analysis. Keywords: Micro-electro-mechanical Systems (MEMS); Electret Condenser Microphone (ECM); Wearable Sensing Devices; Cardiorespiratory Auscultation; Phonocardiography (PCG); Heart Sound; Lung Sound

Heart sound auscultation has been demonstrated to be beneficial in clinical usage for early screening of cardiovascular diseases. Due to the high requirement of well-trained professionals for auscultation, automatic auscultation benefiting from signal processing and machine learning can help auxiliary diagnosis and reduce the burdens of training professional clinicians. Nevertheless, classic machine learning is limited to performance improvement in the era of big data. Deep learning has achieved better performance than classic machine learning in many research fields, as it employs more complex model architectures with stronger capability of extracting effective representations. Deep learning has been successfully applied to heart sound analysis in the past years. As most review works about heart sound analysis were given before 2017, the present survey is the first to work on a comprehensive overview to summarise papers on heart sound analysis with deep learning in the past six years 2017--2022. We introduce both classic machine learning and deep learning for comparison, and further offer insights about the advances and future research directions in deep learning for heart sound analysis.

Today, data collection has improved in various areas, and the medical domain is no exception. Auscultation, as an important diagnostic technique for physicians, due to the progress and availability of digital stethoscopes, lends itself well to applications of machine learning. Due to the large number of auscultations performed, the availability of data opens up an opportunity for more effective analysis of sounds where prognostic accuracy even among experts remains low. In this study, digital 6-channel auscultations of 45 patients were used in various machine learning scenarios, with the aim of distinguishing between normal and anomalous pulmonary sounds. Audio features (such as fundamental frequencies F0-4, loudness, HNR, DFA, as well as descriptive statistics of log energy, RMS and MFCC) were extracted using the Python library Surfboard. Windowing and feature aggregation and concatenation strategies were used to prepare data for tree-based ensemble models in unsupervised (fair-cut forest) and supervised (random forest) machine learning settings. The evaluation was carried out using 9-fold stratified cross-validation repeated 30 times. Decision fusion by averaging outputs for a subject was tested and found to be useful. Supervised models showed a consistent advantage over unsupervised ones, achieving mean AUC ROC of 0.691 (accuracy 71.11%, Kappa 0.416, F1-score 0.771) in side-based detection and mean AUC ROC of 0.721 (accuracy 68.89%, Kappa 0.371, F1-score 0.650) in patient-based detection.

Since most developed countries are facing an increase in the number of patients per healthcare worker due to a declining birth rate and an aging population, relatively simple and safe diagnosis tasks may need to be performed using robotics and automation technologies, without specialists and hospitals. This study presents an automated robotic platform for remote auscultation, which is a highly cost-effective screening tool for detecting abnormal clinical signs. The developed robotic platform is composed of a 6-degree-of-freedom cooperative robotic arm, light detection and ranging (LiDAR) camera, and a spring-based mechanism holding an electric stethoscope. The platform enables autonomous stethoscope positioning based on external body information acquired using the LiDAR camera-based multi-way registration; the platform also ensures safe and flexible contact, maintaining the contact force within a certain range through the passive mechanism. Our preliminary results confirm that the robotic platform enables estimation of the landing positions required for cardiac examinations based on the depth and landmark information of the body surface. It also handles the stethoscope while maintaining the contact force without relying on the push-in displacement by the robotic arm.

A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchi labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests for long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.

Auscultation is a method for diagnosis of especially internal medicine diseases such as cardiac, pulmonary and cardio-pulmonary by listening the internal sounds from the body parts. It is the simplest and the most common physical examination in the assessment processes of the clinical skills. In this study, the lung and heart sounds are recorded synchronously from left and right sides of posterior and anterior chest wall and back using two digital stethoscopes in Antakya State Hospital. The chest X-rays and the pulmonary function test variables and spirometric curves, the St. George respiratory questionnaire (SGRQ-C) are collected as multimedia and clinical functional analysis variables of the patients. The 4 channels of heart sounds are focused on aortic, pulmonary, tricuspid and mitral areas. The 12 channels of lung sounds are focused on upper lung, middle lung, lower lung and costophrenic angle areas of posterior and anterior sides of the chest. The recordings are validated and labelled by two pulmonologists evaluating the collected chest x-ray, PFT and auscultation sounds of the subjects. The database consists of 30 healthy subjects and 45 subjects with pulmonary diseases such as asthma, chronic obstructive pulmonary disease, bronchitis. The novelties of the database are the combination ability between auscultation sound results, chest X-ray and PFT; synchronously assessment capability of the lungs sounds; image processing based computerized analysis of the respiratory using chest X-ray and providing opportunity for improving analysis of both lung sounds and heart sounds on pulmonary and cardiac diseases.

Respiratory auscultation can help healthcare professionals detect abnormal respiratory conditions if adventitious lung sounds are heard. The state-of-the-art artificial intelligence technologies based on deep learning show great potential in the development of automated respiratory sound analysis. To train a deep learning-based model, a huge number of accurate labels of normal breath sounds and adventitious sounds are needed. In this paper, we demonstrate the work of developing a respiratory sound labeling software to help annotators identify and label the inhalation, exhalation, and adventitious respiratory sound more accurately and quickly. Our labeling software integrates six features from MATLAB Audio Labeler, and one commercial audio editor, RX7. As of October, 2019, we have labeled 9,765 15-second-long audio files of breathing lung sounds, and accrued 34,095 inhalation labels,18,349 exhalation labels, 13,883 continuous adventitious sounds (CASs) labels and 15,606 discontinuous adventitious sounds (DASs) labels, which are significantly larger than previously published studies. The trained convolutional recurrent neural networks based on these labels showed good performance with F1-scores of 86.0% on inhalation event detection, 51.6% on CASs event detection and 71.4% on DASs event detection. In conclusion, our results show that our proposed respiratory sound labeling software could easily pre-define a label, perform one-click labeling, and overall facilitate the process of accurately labeling. This software helps develop deep learning-based models that require a huge amount of labeled acoustic data.