Continual learning (CL) methods designed for natural image classification often fail to reach basic quality standards for medical image segmentation. Atlas-based segmentation, a well-established approach in medical imaging, incorporates domain knowledge on the region of interest, leading to semantically coherent predictions. This is especially promising for CL, as it allows us to leverage structural information and strike an optimal balance between model rigidity and plasticity over time. When combined with privacy-preserving prototypes, this process offers the advantages of rehearsal-based CL without compromising patient privacy. We propose Atlas Replay, an atlas-based segmentation approach that uses prototypes to generate high-quality segmentation masks through image registration that maintain consistency even as the training distribution changes. We explore how our proposed method performs compared to state-of-the-art CL methods in terms of knowledge transferability across seven publicly available prostate segmentation datasets. Prostate segmentation plays a vital role in diagnosing prostate cancer, however, it poses challenges due to substantial anatomical variations, benign structural differences in older age groups, and fluctuating acquisition parameters. Our results show that Atlas Replay is both robust and generalizes well to yet-unseen domains while being able to maintain knowledge, unlike end-to-end segmentation methods. Our code base is available under https://github.com/MECLabTUDA/Atlas-Replay.
Automatic intracranial hemorrhage segmentation in 3D non-contrast head CT (NCCT) scans is significant in clinical practice. Existing hemorrhage segmentation methods usually ignores the anisotropic nature of the NCCT, and are evaluated on different in-house datasets with distinct metrics, making it highly challenging to improve segmentation performance and perform objective comparisons among different methods. The INSTANCE 2022 was a grand challenge held in conjunction with the 2022 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). It is intended to resolve the above-mentioned problems and promote the development of both intracranial hemorrhage segmentation and anisotropic data processing. The INSTANCE released a training set of 100 cases with ground-truth and a validation set with 30 cases without ground-truth labels that were available to the participants. A held-out testing set with 70 cases is utilized for the final evaluation and ranking. The methods from different participants are ranked based on four metrics, including Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), Relative Volume Difference (RVD) and Normalized Surface Dice (NSD). A total of 13 teams submitted distinct solutions to resolve the challenges, making several baseline models, pre-processing strategies and anisotropic data processing techniques available to future researchers. The winner method achieved an average DSC of 0.6925, demonstrating a significant growth over our proposed baseline method. To the best of our knowledge, the proposed INSTANCE challenge releases the first intracranial hemorrhage segmentation benchmark, and is also the first challenge that intended to resolve the anisotropic problem in 3D medical image segmentation, which provides new alternatives in these research fields.