PULASki: Learning inter-rater variability using statistical distances to improve probabilistic segmentation

In the domain of medical imaging, many supervised learning based methods for segmentation face several challenges such as high variability in annotations from multiple experts, paucity of labelled data and class imbalanced datasets. These issues may result in segmentations that lack the requisite precision for clinical analysis and can be misleadingly overconfident without associated uncertainty quantification. We propose the PULASki for biomedical image segmentation that accurately captures variability in expert annotations, even in small datasets. Our approach makes use of an improved loss function based on statistical distances in a conditional variational autoencoder structure (Probabilistic UNet), which improves learning of the conditional decoder compared to the standard cross-entropy particularly in class imbalanced problems. We analyse our method for two structurally different segmentation tasks (intracranial vessel and multiple sclerosis (MS) lesion) and compare our results to four well-established baselines in terms of quantitative metrics and qualitative output. Empirical results demonstrate the PULASKi method outperforms all baselines at the 5\% significance level. The generated segmentations are shown to be much more anatomically plausible than in the 2D case, particularly for the vessel task. Our method can also be applied to a wide range of multi-label segmentation tasks and and is useful for downstream tasks such as hemodynamic modelling (computational fluid dynamics and data assimilation), clinical decision making, and treatment planning.

Fourier PD and PDUNet: Complex-valued networks to speed-up MR Thermometry during Hypterthermia

Hyperthermia (HT) in combination with radio- and/or chemotherapy has become an accepted cancer treatment for distinct solid tumour entities. In HT, tumour tissue is exogenously heated to temperatures of 39 to 43 $\degree$C for 60 minutes. Temperature monitoring can be performed noninvasively using dynamic magnetic resonance imaging (MRI). However, the slow nature of MRI leads to motion artefacts in the images due to the movements of patients during image acquisition time. By discarding parts of the data, the speed of the acquisition can be increased - known as Undersampling. However, due to the invalidation of the Nyquist criterion, the acquired images have lower resolution and can also produce artefacts. The aim of this work was, therefore, to reconstruct highly undersampled MR thermometry acquisitions with better resolution and with less artefacts compared to conventional techniques like compressed sensing. The use of deep learning in the medical field has emerged in recent times, and various studies have shown that deep learning has the potential to solve inverse problems such as MR image reconstruction. However, most of the published work only focusses on the magnitude images, while the phase images are ignored, which are fundamental requirements for MR thermometry. This work, for the first time ever, presents deep learning based solutions for reconstructing undersampled MR thermometry data. Two different deep learning models have been employed here, the Fourier Primal-Dual network and Fourier Primal-Dual UNet, to reconstruct highly undersampled complex images of MR thermometry. It was observed that the method was able to reduce the temperature difference between the undersampled MRIs and the fully sampled MRIs from 1.5 $\degree$C to 0.5 $\degree$C.

MedShapeNet -- A Large-Scale Dataset of 3D Medical Shapes for Computer Vision

We present MedShapeNet, a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D surgical instrument models. Prior to the deep learning era, the broad application of statistical shape models (SSMs) in medical image analysis is evidence that shapes have been commonly used to describe medical data. Nowadays, however, state-of-the-art (SOTA) deep learning algorithms in medical imaging are predominantly voxel-based. In computer vision, on the contrary, shapes (including, voxel occupancy grids, meshes, point clouds and implicit surface models) are preferred data representations in 3D, as seen from the numerous shape-related publications in premier vision conferences, such as the IEEE/CVF Conference on Computer Vision and Pattern Recognition (CVPR), as well as the increasing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models) in computer vision research. MedShapeNet is created as an alternative to these commonly used shape benchmarks to facilitate the translation of data-driven vision algorithms to medical applications, and it extends the opportunities to adapt SOTA vision algorithms to solve critical medical problems. Besides, the majority of the medical shapes in MedShapeNet are modeled directly on the imaging data of real patients, and therefore it complements well existing shape benchmarks comprising of computer-aided design (CAD) models. MedShapeNet currently includes more than 100,000 medical shapes, and provides annotations in the form of paired data. It is therefore also a freely available repository of 3D models for extended reality (virtual reality - VR, augmented reality - AR, mixed reality - MR) and medical 3D printing. This white paper describes in detail the motivations behind MedShapeNet, the shape acquisition procedures, the use cases, as well as the usage of the online shape search portal: https://medshapenet.ikim.nrw/

Liver Segmentation in Time-resolved C-arm CT Volumes Reconstructed from Dynamic Perfusion Scans using Time Separation Technique

Perfusion imaging is a valuable tool for diagnosing and treatment planning for liver tumours. The time separation technique (TST) has been successfully used for modelling C-arm cone-beam computed tomography (CBCT) perfusion data. The reconstruction can be accompanied by the segmentation of the liver - for better visualisation and for generating comprehensive perfusion maps. Recently introduced Turbolift learning has been seen to perform well while working with TST reconstructions, but has not been explored for the time-resolved volumes (TRV) estimated out of TST reconstructions. The segmentation of the TRVs can be useful for tracking the movement of the liver over time. This research explores this possibility by training the multi-scale attention UNet of Turbolift learning at its third stage on the TRVs and shows the robustness of Turbolift learning since it can even work efficiently with the TRVs, resulting in a Dice score of 0.864$\pm$0.004.

Complex Network for Complex Problems: A comparative study of CNN and Complex-valued CNN

Neural networks, especially convolutional neural networks (CNN), are one of the most common tools these days used in computer vision. Most of these networks work with real-valued data using real-valued features. Complex-valued convolutional neural networks (CV-CNN) can preserve the algebraic structure of complex-valued input data and have the potential to learn more complex relationships between the input and the ground-truth. Although some comparisons of CNNs and CV-CNNs for different tasks have been performed in the past, a large-scale investigation comparing different models operating on different tasks has not been conducted. Furthermore, because complex features contain both real and imaginary components, CV-CNNs have double the number of trainable parameters as real-valued CNNs in terms of the actual number of trainable parameters. Whether or not the improvements in performance with CV-CNN observed in the past have been because of the complex features or just because of having double the number of trainable parameters has not yet been explored. This paper presents a comparative study of CNN, CNNx2 (CNN with double the number of trainable parameters as the CNN), and CV-CNN. The experiments were performed using seven models for two different tasks - brain tumour classification and segmentation in brain MRIs. The results have revealed that the CV-CNN models outperformed the CNN and CNNx2 models.

Liver Segmentation using Turbolift Learning for CT and Cone-beam C-arm Perfusion Imaging

Model-based reconstruction employing the time separation technique (TST) was found to improve dynamic perfusion imaging of the liver using C-arm cone-beam computed tomography (CBCT). To apply TST using prior knowledge extracted from CT perfusion data, the liver should be accurately segmented from the CT scans. Reconstructions of primary and model-based CBCT data need to be segmented for proper visualisation and interpretation of perfusion maps. This research proposes Turbolift learning, which trains a modified version of the multi-scale Attention UNet on different liver segmentation tasks serially, following the order of the trainings CT, CBCT, CBCT TST - making the previous trainings act as pre-training stages for the subsequent ones - addressing the problem of limited number of datasets for training. For the final task of liver segmentation from CBCT TST, the proposed method achieved an overall Dice scores of 0.874$\pm$0.031 and 0.905$\pm$0.007 in 6-fold and 4-fold cross-validation experiments, respectively - securing statistically significant improvements over the model, which was trained only for that task. Experiments revealed that Turbolift not only improves the overall performance of the model but also makes it robust against artefacts originating from the embolisation materials and truncation artefacts. Additionally, in-depth analyses confirmed the order of the segmentation tasks. This paper shows the potential of segmenting the liver from CT, CBCT, and CBCT TST, learning from the available limited training data, which can possibly be used in the future for the visualisation and evaluation of the perfusion maps for the treatment evaluation of liver diseases.

Automated SSIM Regression for Detection and Quantification of Motion Artefacts in Brain MR Images

Motion artefacts in magnetic resonance brain images are a crucial issue. The assessment of MR image quality is fundamental before proceeding with the clinical diagnosis. If the motion artefacts alter a correct delineation of structure and substructures of the brain, lesions, tumours and so on, the patients need to be re-scanned. Otherwise, neuro-radiologists could report an inaccurate or incorrect diagnosis. The first step right after scanning a patient is the "\textit{image quality assessment}" in order to decide if the acquired images are diagnostically acceptable. An automated image quality assessment based on the structural similarity index (SSIM) regression through a residual neural network has been proposed here, with the possibility to perform also the classification in different groups - by subdividing with SSIM ranges. This method predicts SSIM values of an input image in the absence of a reference ground truth image. The networks were able to detect motion artefacts, and the best performance for the regression and classification task has always been achieved with ResNet-18 with contrast augmentation. Mean and standard deviation of residuals' distribution were $\mu=-0.0009$ and $\sigma=0.0139$, respectively. Whilst for the classification task in 3, 5 and 10 classes, the best accuracies were 97, 95 and 89\%, respectively. The obtained results show that the proposed method could be a tool in supporting neuro-radiologists and radiographers in evaluating the image quality before the diagnosis.

Weakly-supervised segmentation using inherently-explainable classification models and their application to brain tumour classification

Deep learning models have shown their potential for several applications. However, most of the models are opaque and difficult to trust due to their complex reasoning - commonly known as the black-box problem. Some fields, such as medicine, require a high degree of transparency to accept and adopt such technologies. Consequently, creating explainable/interpretable models or applying post-hoc methods on classifiers to build trust in deep learning models are required. Moreover, deep learning methods can be used for segmentation tasks, which typically require hard-to-obtain, time-consuming manually-annotated segmentation labels for training. This paper introduces three inherently-explainable classifiers to tackle both of these problems as one. The localisation heatmaps provided by the networks -- representing the models' focus areas and being used in classification decision-making -- can be directly interpreted, without requiring any post-hoc methods to derive information for model explanation. The models are trained by using the input image and only the classification labels as ground-truth in a supervised fashion - without using any information about the location of the region of interest (i.e. the segmentation labels), making the segmentation training of the models weakly-supervised through classification labels. The final segmentation is obtained by thresholding these heatmaps. The models were employed for the task of multi-class brain tumour classification using two different datasets, resulting in the best F1-score of 0.93 for the supervised classification task while securing a median Dice score of 0.67$\pm$0.08 for the weakly-supervised segmentation task. Furthermore, the obtained accuracy on a subset of tumour-only images outperformed the state-of-the-art glioma tumour grading binary classifiers with the best model achieving 98.7\% accuracy.

Primal-Dual UNet for Sparse View Cone Beam Computed Tomography Volume Reconstruction

In this paper, the Primal-Dual UNet for sparse view CT reconstruction is modified to be applicable to cone beam projections and perform reconstructions of entire volumes instead of slices. Experiments show that the PSNR of the proposed method is increased by 10dB compared to the direct FDK reconstruction and almost 3dB compared to the modified original Primal-Dual Network when using only 23 projections. The presented network is not optimized wrt. memory consumption or hyperparameters but merely serves as a proof of concept and is limited to low resolution projections and volumes.

Dual Branch Prior-SegNet: CNN for Interventional CBCT using Planning Scan and Auxiliary Segmentation Loss

This paper proposes an extension to the Dual Branch Prior-Net for sparse view interventional CBCT reconstruction incorporating a high quality planning scan. An additional head learns to segment interventional instruments and thus guides the reconstruction task. The prior scans are misaligned by up to +-5deg in-plane during training. Experiments show that the proposed model, Dual Branch Prior-SegNet, significantly outperforms any other evaluated model by >2.8dB PSNR. It also stays robust wrt. rotations of up to +-5.5deg.