Diffusion Models with Ensembled Structure-Based Anomaly Scoring for Unsupervised Anomaly Detection

Supervised deep learning techniques show promise in medical image analysis. However, they require comprehensive annotated data sets, which poses challenges, particularly for rare diseases. Consequently, unsupervised anomaly detection (UAD) emerges as a viable alternative for pathology segmentation, as only healthy data is required for training. However, recent UAD anomaly scoring functions often focus on intensity only and neglect structural differences, which impedes the segmentation performance. This work investigates the potential of Structural Similarity (SSIM) to bridge this gap. SSIM captures both intensity and structural disparities and can be advantageous over the classical $l1$ error. However, we show that there is more than one optimal kernel size for the SSIM calculation for different pathologies. Therefore, we investigate an adaptive ensembling strategy for various kernel sizes to offer a more pathology-agnostic scoring mechanism. We demonstrate that this ensembling strategy can enhance the performance of DMs and mitigate the sensitivity to different kernel sizes across varying pathologies, highlighting its promise for brain MRI anomaly detection.

A Modified da Vinci Surgical Instrument for OCE based Elasticity Estimation with Deep Learning

Robot-assisted surgery has advantages compared to conventional laparoscopic procedures, e.g., precise movement of the surgical instruments, improved dexterity, and high-resolution visualization of the surgical field. However, mechanical tissue properties may provide additional information, e.g., on the location of lesions or vessels. While elastographic imaging has been proposed, it is not readily available as an online modality during robot-assisted surgery. We propose modifying a da~Vinci surgical instrument to realize optical coherence elastography (OCE) for quantitative elasticity estimation. The modified da~Vinci instrument is equipped with piezoelectric elements for shear wave excitation and we employ fast optical coherence tomography (OCT) imaging to track propagating wave fields, which are directly related to biomechanical tissue properties. All high-voltage components are mounted at the proximal end outside the patient. We demonstrate that external excitation at the instrument shaft can effectively stimulate shear waves, even when considering damping. Comparing conventional and deep learning-based signal processing, resulting in mean absolute errors of 19.27 kPa and 6.29 kPa, respectively. These results illustrate that precise quantitative elasticity estimates can be obtained. We also demonstrate quantitative elasticity estimation on ex-vivo tissue samples of heart, liver and stomach, and show that the measurements can be used to distinguish soft and stiff tissue types.

PolypNextLSTM: A lightweight and fast polyp video segmentation network using ConvNext and ConvLSTM

Commonly employed in polyp segmentation, single image UNet architectures lack the temporal insight clinicians gain from video data in diagnosing polyps. To mirror clinical practices more faithfully, our proposed solution, PolypNextLSTM, leverages video-based deep learning, harnessing temporal information for superior segmentation performance with the least parameter overhead, making it possibly suitable for edge devices. PolypNextLSTM employs a UNet-like structure with ConvNext-Tiny as its backbone, strategically omitting the last two layers to reduce parameter overhead. Our temporal fusion module, a Convolutional Long Short Term Memory (ConvLSTM), effectively exploits temporal features. Our primary novelty lies in PolypNextLSTM, which stands out as the leanest in parameters and the fastest model, surpassing the performance of five state-of-the-art image and video-based deep learning models. The evaluation of the SUN-SEG dataset spans easy-to-detect and hard-to-detect polyp scenarios, along with videos containing challenging artefacts like fast motion and occlusion. Comparison against 5 image-based and 5 video-based models demonstrates PolypNextLSTM's superiority, achieving a Dice score of 0.7898 on the hard-to-detect polyp test set, surpassing image-based PraNet (0.7519) and video-based PNSPlusNet (0.7486). Notably, our model excels in videos featuring complex artefacts such as ghosting and occlusion. PolypNextLSTM, integrating pruned ConvNext-Tiny with ConvLSTM for temporal fusion, not only exhibits superior segmentation performance but also maintains the highest frames per speed among evaluated models. Access code here https://github.com/mtec-tuhh/PolypNextLSTM

Nodule detection and generation on chest X-rays: NODE21 Challenge

Pulmonary nodules may be an early manifestation of lung cancer, the leading cause of cancer-related deaths among both men and women. Numerous studies have established that deep learning methods can yield high-performance levels in the detection of lung nodules in chest X-rays. However, the lack of gold-standard public datasets slows down the progression of the research and prevents benchmarking of methods for this task. To address this, we organized a public research challenge, NODE21, aimed at the detection and generation of lung nodules in chest X-rays. While the detection track assesses state-of-the-art nodule detection systems, the generation track determines the utility of nodule generation algorithms to augment training data and hence improve the performance of the detection systems. This paper summarizes the results of the NODE21 challenge and performs extensive additional experiments to examine the impact of the synthetically generated nodule training images on the detection algorithm performance.

Guided Reconstruction with Conditioned Diffusion Models for Unsupervised Anomaly Detection in Brain MRIs

Unsupervised anomaly detection in Brain MRIs aims to identify abnormalities as outliers from a healthy training distribution. Reconstruction-based approaches that use generative models to learn to reconstruct healthy brain anatomy are commonly used for this task. Diffusion models are an emerging class of deep generative models that show great potential regarding reconstruction fidelity. However, they face challenges in preserving intensity characteristics in the reconstructed images, limiting their performance in anomaly detection. To address this challenge, we propose to condition the denoising mechanism of diffusion models with additional information about the image to reconstruct coming from a latent representation of the noise-free input image. This conditioning enables high-fidelity reconstruction of healthy brain structures while aligning local intensity characteristics of input-reconstruction pairs. We evaluate our method's reconstruction quality, domain adaptation features and finally segmentation performance on publicly available data sets with various pathologies. Using our proposed conditioning mechanism we can reduce the false-positive predictions and enable a more precise delineation of anomalies which significantly enhances the anomaly detection performance compared to established state-of-the-art approaches to unsupervised anomaly detection in brain MRI. Furthermore, our approach shows promise in domain adaptation across different MRI acquisitions and simulated contrasts, a crucial property of general anomaly detection methods.

An objective validation of polyp and instrument segmentation methods in colonoscopy through Medico 2020 polyp segmentation and MedAI 2021 transparency challenges

Automatic analysis of colonoscopy images has been an active field of research motivated by the importance of early detection of precancerous polyps. However, detecting polyps during the live examination can be challenging due to various factors such as variation of skills and experience among the endoscopists, lack of attentiveness, and fatigue leading to a high polyp miss-rate. Deep learning has emerged as a promising solution to this challenge as it can assist endoscopists in detecting and classifying overlooked polyps and abnormalities in real time. In addition to the algorithm's accuracy, transparency and interpretability are crucial to explaining the whys and hows of the algorithm's prediction. Further, most algorithms are developed in private data, closed source, or proprietary software, and methods lack reproducibility. Therefore, to promote the development of efficient and transparent methods, we have organized the "Medico automatic polyp segmentation (Medico 2020)" and "MedAI: Transparency in Medical Image Segmentation (MedAI 2021)" competitions. We present a comprehensive summary and analyze each contribution, highlight the strength of the best-performing methods, and discuss the possibility of clinical translations of such methods into the clinic. For the transparency task, a multi-disciplinary team, including expert gastroenterologists, accessed each submission and evaluated the team based on open-source practices, failure case analysis, ablation studies, usability and understandability of evaluations to gain a deeper understanding of the models' credibility for clinical deployment. Through the comprehensive analysis of the challenge, we not only highlight the advancements in polyp and surgical instrument segmentation but also encourage qualitative evaluation for building more transparent and understandable AI-based colonoscopy systems.

Collaborative Robotic Biopsy with Trajectory Guidance and Needle Tip Force Feedback

The diagnostic value of biopsies is highly dependent on the placement of needles. Robotic trajectory guidance has been shown to improve needle positioning, but feedback for real-time navigation is limited. Haptic display of needle tip forces can provide rich feedback for needle navigation by enabling localization of tissue structures along the insertion path. We present a collaborative robotic biopsy system that combines trajectory guidance with kinesthetic feedback to assist the physician in needle placement. The robot aligns the needle while the insertion is performed in collaboration with a medical expert who controls the needle position on site. We present a needle design that senses forces at the needle tip based on optical coherence tomography and machine learning for real-time data processing. Our robotic setup allows operators to sense deep tissue interfaces independent of frictional forces to improve needle placement relative to a desired target structure. We first evaluate needle tip force sensing in ex-vivo tissue in a phantom study. We characterize the tip forces during insertions with constant velocity and demonstrate the ability to detect tissue interfaces in a collaborative user study. Participants are able to detect 91% of ex-vivo tissue interfaces based on needle tip force feedback alone. Finally, we demonstrate that even smaller, deep target structures can be accurately sampled by performing post-mortem in situ biopsies of the pancreas.

Tissue Classification During Needle Insertion Using Self-Supervised Contrastive Learning and Optical Coherence Tomography

Needle positioning is essential for various medical applications such as epidural anaesthesia. Physicians rely on their instincts while navigating the needle in epidural spaces. Thereby, identifying the tissue structures may be helpful to the physician as they can provide additional feedback in the needle insertion process. To this end, we propose a deep neural network that classifies the tissues from the phase and intensity data of complex OCT signals acquired at the needle tip. We investigate the performance of the deep neural network in a limited labelled dataset scenario and propose a novel contrastive pretraining strategy that learns invariant representation for phase and intensity data. We show that with 10% of the training set, our proposed pretraining strategy helps the model achieve an F1 score of 0.84 whereas the model achieves an F1 score of 0.60 without it. Further, we analyse the importance of phase and intensity individually towards tissue classification.

Multiple Instance Ensembling For Paranasal Anomaly Classification In The Maxillary Sinus

Paranasal anomalies are commonly discovered during routine radiological screenings and can present with a wide range of morphological features. This diversity can make it difficult for convolutional neural networks (CNNs) to accurately classify these anomalies, especially when working with limited datasets. Additionally, current approaches to paranasal anomaly classification are constrained to identifying a single anomaly at a time. These challenges necessitate the need for further research and development in this area. In this study, we investigate the feasibility of using a 3D convolutional neural network (CNN) to classify healthy maxillary sinuses (MS) and MS with polyps or cysts. The task of accurately identifying the relevant MS volume within larger head and neck Magnetic Resonance Imaging (MRI) scans can be difficult, but we develop a straightforward strategy to tackle this challenge. Our end-to-end solution includes the use of a novel sampling technique that not only effectively localizes the relevant MS volume, but also increases the size of the training dataset and improves classification results. Additionally, we employ a multiple instance ensemble prediction method to further boost classification performance. Finally, we identify the optimal size of MS volumes to achieve the highest possible classification performance on our dataset. With our multiple instance ensemble prediction strategy and sampling strategy, our 3D CNNs achieve an F1 of 0.85 whereas without it, they achieve an F1 of 0.70. We demonstrate the feasibility of classifying anomalies in the MS. We propose a data enlarging strategy alongside a novel ensembling strategy that proves to be beneficial for paranasal anomaly classification in the MS.