Comparative Benchmarking of Failure Detection Methods in Medical Image Segmentation: Unveiling the Role of Confidence Aggregation

Semantic segmentation is an essential component of medical image analysis research, with recent deep learning algorithms offering out-of-the-box applicability across diverse datasets. Despite these advancements, segmentation failures remain a significant concern for real-world clinical applications, necessitating reliable detection mechanisms. This paper introduces a comprehensive benchmarking framework aimed at evaluating failure detection methodologies within medical image segmentation. Through our analysis, we identify the strengths and limitations of current failure detection metrics, advocating for the risk-coverage analysis as a holistic evaluation approach. Utilizing a collective dataset comprising five public 3D medical image collections, we assess the efficacy of various failure detection strategies under realistic test-time distribution shifts. Our findings highlight the importance of pixel confidence aggregation and we observe superior performance of the pairwise Dice score (Roy et al., 2019) between ensemble predictions, positioning it as a simple and robust baseline for failure detection in medical image segmentation. To promote ongoing research, we make the benchmarking framework available to the community.

Leveraging Foundation Models for Content-Based Medical Image Retrieval in Radiology

Content-based image retrieval (CBIR) has the potential to significantly improve diagnostic aid and medical research in radiology. Current CBIR systems face limitations due to their specialization to certain pathologies, limiting their utility. In response, we propose using vision foundation models as powerful and versatile off-the-shelf feature extractors for content-based medical image retrieval. By benchmarking these models on a comprehensive dataset of 1.6 million 2D radiological images spanning four modalities and 161 pathologies, we identify weakly-supervised models as superior, achieving a P@1 of up to 0.594. This performance not only competes with a specialized model but does so without the need for fine-tuning. Our analysis further explores the challenges in retrieving pathological versus anatomical structures, indicating that accurate retrieval of pathological features presents greater difficulty. Despite these challenges, our research underscores the vast potential of foundation models for CBIR in radiology, proposing a shift towards versatile, general-purpose medical image retrieval systems that do not require specific tuning.

RecycleNet: Latent Feature Recycling Leads to Iterative Decision Refinement

Despite the remarkable success of deep learning systems over the last decade, a key difference still remains between neural network and human decision-making: As humans, we cannot only form a decision on the spot, but also ponder, revisiting an initial guess from different angles, distilling relevant information, arriving at a better decision. Here, we propose RecycleNet, a latent feature recycling method, instilling the pondering capability for neural networks to refine initial decisions over a number of recycling steps, where outputs are fed back into earlier network layers in an iterative fashion. This approach makes minimal assumptions about the neural network architecture and thus can be implemented in a wide variety of contexts. Using medical image segmentation as the evaluation environment, we show that latent feature recycling enables the network to iteratively refine initial predictions even beyond the iterations seen during training, converging towards an improved decision. We evaluate this across a variety of segmentation benchmarks and show consistent improvements even compared with top-performing segmentation methods. This allows trading increased computation time for improved performance, which can be beneficial, especially for safety-critical applications.

Exploring new ways: Enforcing representational dissimilarity to learn new features and reduce error consistency

Independently trained machine learning models tend to learn similar features. Given an ensemble of independently trained models, this results in correlated predictions and common failure modes. Previous attempts focusing on decorrelation of output predictions or logits yielded mixed results, particularly due to their reduction in model accuracy caused by conflicting optimization objectives. In this paper, we propose the novel idea of utilizing methods of the representational similarity field to promote dissimilarity during training instead of measuring similarity of trained models. To this end, we promote intermediate representations to be dissimilar at different depths between architectures, with the goal of learning robust ensembles with disjoint failure modes. We show that highly dissimilar intermediate representations result in less correlated output predictions and slightly lower error consistency, resulting in higher ensemble accuracy. With this, we shine first light on the connection between intermediate representations and their impact on the output predictions.

SAM.MD: Zero-shot medical image segmentation capabilities of the Segment Anything Model

Foundation models have taken over natural language processing and image generation domains due to the flexibility of prompting. With the recent introduction of the Segment Anything Model (SAM), this prompt-driven paradigm has entered image segmentation with a hitherto unexplored abundance of capabilities. The purpose of this paper is to conduct an initial evaluation of the out-of-the-box zero-shot capabilities of SAM for medical image segmentation, by evaluating its performance on an abdominal CT organ segmentation task, via point or bounding box based prompting. We show that SAM generalizes well to CT data, making it a potential catalyst for the advancement of semi-automatic segmentation tools for clinicians. We believe that this foundation model, while not reaching state-of-the-art segmentation performance in our investigations, can serve as a highly potent starting point for further adaptations of such models to the intricacies of the medical domain. Keywords: medical image segmentation, SAM, foundation models, zero-shot learning

Why is the winner the best?

International benchmarking competitions have become fundamental for the comparative performance assessment of image analysis methods. However, little attention has been given to investigating what can be learnt from these competitions. Do they really generate scientific progress? What are common and successful participation strategies? What makes a solution superior to a competing method? To address this gap in the literature, we performed a multi-center study with all 80 competitions that were conducted in the scope of IEEE ISBI 2021 and MICCAI 2021. Statistical analyses performed based on comprehensive descriptions of the submitted algorithms linked to their rank as well as the underlying participation strategies revealed common characteristics of winning solutions. These typically include the use of multi-task learning (63%) and/or multi-stage pipelines (61%), and a focus on augmentation (100%), image preprocessing (97%), data curation (79%), and postprocessing (66%). The "typical" lead of a winning team is a computer scientist with a doctoral degree, five years of experience in biomedical image analysis, and four years of experience in deep learning. Two core general development strategies stood out for highly-ranked teams: the reflection of the metrics in the method design and the focus on analyzing and handling failure cases. According to the organizers, 43% of the winning algorithms exceeded the state of the art but only 11% completely solved the respective domain problem. The insights of our study could help researchers (1) improve algorithm development strategies when approaching new problems, and (2) focus on open research questions revealed by this work.

CRADL: Contrastive Representations for Unsupervised Anomaly Detection and Localization

Unsupervised anomaly detection in medical imaging aims to detect and localize arbitrary anomalies without requiring annotated anomalous data during training. Often, this is achieved by learning a data distribution of normal samples and detecting anomalies as regions in the image which deviate from this distribution. Most current state-of-the-art methods use latent variable generative models operating directly on the images. However, generative models have been shown to mostly capture low-level features, s.a. pixel-intensities, instead of rich semantic features, which also applies to their representations. We circumvent this problem by proposing CRADL whose core idea is to model the distribution of normal samples directly in the low-dimensional representation space of an encoder trained with a contrastive pretext-task. By utilizing the representations of contrastive learning, we aim to fix the over-fixation on low-level features and learn more semantic-rich representations. Our experiments on anomaly detection and localization tasks using three distinct evaluation datasets show that 1) contrastive representations are superior to representations of generative latent variable models and 2) the CRADL framework shows competitive or superior performance to state-of-the-art.

Biomedical image analysis competitions: The state of current participation practice

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

Continuous-Time Deep Glioma Growth Models

The ability to estimate how a tumor might evolve in the future could have tremendous clinical benefits, from improved treatment decisions to better dose distribution in radiation therapy. Recent work has approached the glioma growth modeling problem via deep learning and variational inference, thus learning growth dynamics entirely from a real patient data distribution. So far, this approach was constrained to predefined image acquisition intervals and sequences of fixed length, which limits its applicability in more realistic scenarios. We overcome these limitations by extending Neural Processes, a class of conditional generative models for stochastic time series, with a hierarchical multi-scale representation encoding including a spatio-temporal attention mechanism. The result is a learned growth model that can be conditioned on an arbitrary number of observations, and that can produce a distribution of temporally consistent growth trajectories on a continuous time axis. On a dataset of 379 patients, the approach successfully captures both global and finer-grained variations in the images, exhibiting superior performance compared to other learned growth models.

GP-ConvCNP: Better Generalization for Convolutional Conditional Neural Processes on Time Series Data

Neural Processes (NPs) are a family of conditional generative models that are able to model a distribution over functions, in a way that allows them to perform predictions at test time conditioned on a number of context points. A recent addition to this family, Convolutional Conditional Neural Processes (ConvCNP), have shown remarkable improvement in performance over prior art, but we find that they sometimes struggle to generalize when applied to time series data. In particular, they are not robust to distribution shifts and fail to extrapolate observed patterns into the future. By incorporating a Gaussian Process into the model, we are able to remedy this and at the same time improve performance within distribution. As an added benefit, the Gaussian Process reintroduces the possibility to sample from the model, a key feature of other members in the NP family.