C$^3$PS: Context-aware Conditional Cross Pseudo Supervision for Semi-supervised Medical Image Segmentation

Semi-supervised learning (SSL) methods, which can leverage a large amount of unlabeled data for improved performance, has attracted increasing attention recently. In this paper, we introduce a novel Context-aware Conditional Cross Pseudo Supervision method (referred as C$^3$PS) for semi-supervised medical image segmentation. Unlike previously published Cross Pseudo Supervision (CPS) works, this paper introduces a novel Conditional Cross Pseudo Supervision (CCPS) mechanism where the cross pseudo supervision is conditioned on a given class label. Context-awareness is further introduced in the CCPS to improve the quality of pseudo-labels for cross pseudo supervision. The proposed method has the additional advantage that in the later training stage, it can focus on the learning of hard organs. Validated on two typical yet challenging medical image segmentation tasks, our method demonstrates superior performance over the state-of-the-art methods.

CholecTriplet2022: Show me a tool and tell me the triplet -- an endoscopic vision challenge for surgical action triplet detection

Formalizing surgical activities as triplets of the used instruments, actions performed, and target anatomies is becoming a gold standard approach for surgical activity modeling. The benefit is that this formalization helps to obtain a more detailed understanding of tool-tissue interaction which can be used to develop better Artificial Intelligence assistance for image-guided surgery. Earlier efforts and the CholecTriplet challenge introduced in 2021 have put together techniques aimed at recognizing these triplets from surgical footage. Estimating also the spatial locations of the triplets would offer a more precise intraoperative context-aware decision support for computer-assisted intervention. This paper presents the CholecTriplet2022 challenge, which extends surgical action triplet modeling from recognition to detection. It includes weakly-supervised bounding box localization of every visible surgical instrument (or tool), as the key actors, and the modeling of each tool-activity in the form of <instrument, verb, target> triplet. The paper describes a baseline method and 10 new deep learning algorithms presented at the challenge to solve the task. It also provides thorough methodological comparisons of the methods, an in-depth analysis of the obtained results, their significance, and useful insights for future research directions and applications in surgery.

ARST: Auto-Regressive Surgical Transformer for Phase Recognition from Laparoscopic Videos

Phase recognition plays an essential role for surgical workflow analysis in computer assisted intervention. Transformer, originally proposed for sequential data modeling in natural language processing, has been successfully applied to surgical phase recognition. Existing works based on transformer mainly focus on modeling attention dependency, without introducing auto-regression. In this work, an Auto-Regressive Surgical Transformer, referred as ARST, is first proposed for on-line surgical phase recognition from laparoscopic videos, modeling the inter-phase correlation implicitly by conditional probability distribution. To reduce inference bias and to enhance phase consistency, we further develop a consistency constraint inference strategy based on auto-regression. We conduct comprehensive validations on a well-known public dataset Cholec80. Experimental results show that our method outperforms the state-of-the-art methods both quantitatively and qualitatively, and achieves an inference rate of 66 frames per second (fps).

KiPA22 Report: U-Net with Contour Regularization for Renal Structures Segmentation

Three-dimensional (3D) integrated renal structures (IRS) segmentation is important in clinical practice. With the advancement of deep learning techniques, many powerful frameworks focusing on medical image segmentation are proposed. In this challenge, we utilized the nnU-Net framework, which is the state-of-the-art method for medical image segmentation. To reduce the outlier prediction for the tumor label, we combine contour regularization (CR) loss of the tumor label with Dice loss and cross-entropy loss to improve this phenomenon.

Calibrating Label Distribution for Class-Imbalanced Barely-Supervised Knee Segmentation

Segmentation of 3D knee MR images is important for the assessment of osteoarthritis. Like other medical data, the volume-wise labeling of knee MR images is expertise-demanded and time-consuming; hence semi-supervised learning (SSL), particularly barely-supervised learning, is highly desirable for training with insufficient labeled data. We observed that the class imbalance problem is severe in the knee MR images as the cartilages only occupy 6% of foreground volumes, and the situation becomes worse without sufficient labeled data. To address the above problem, we present a novel framework for barely-supervised knee segmentation with noisy and imbalanced labels. Our framework leverages label distribution to encourage the network to put more effort into learning cartilage parts. Specifically, we utilize 1.) label quantity distribution for modifying the objective loss function to a class-aware weighted form and 2.) label position distribution for constructing a cropping probability mask to crop more sub-volumes in cartilage areas from both labeled and unlabeled inputs. In addition, we design dual uncertainty-aware sampling supervision to enhance the supervision of low-confident categories for efficient unsupervised learning. Experiments show that our proposed framework brings significant improvements by incorporating the unlabeled data and alleviating the problem of class imbalance. More importantly, our method outperforms the state-of-the-art SSL methods, demonstrating the potential of our framework for the more challenging SSL setting.

CholecTriplet2021: A benchmark challenge for surgical action triplet recognition

Context-aware decision support in the operating room can foster surgical safety and efficiency by leveraging real-time feedback from surgical workflow analysis. Most existing works recognize surgical activities at a coarse-grained level, such as phases, steps or events, leaving out fine-grained interaction details about the surgical activity; yet those are needed for more helpful AI assistance in the operating room. Recognizing surgical actions as triplets of <instrument, verb, target> combination delivers comprehensive details about the activities taking place in surgical videos. This paper presents CholecTriplet2021: an endoscopic vision challenge organized at MICCAI 2021 for the recognition of surgical action triplets in laparoscopic videos. The challenge granted private access to the large-scale CholecT50 dataset, which is annotated with action triplet information. In this paper, we present the challenge setup and assessment of the state-of-the-art deep learning methods proposed by the participants during the challenge. A total of 4 baseline methods from the challenge organizers and 19 new deep learning algorithms by competing teams are presented to recognize surgical action triplets directly from surgical videos, achieving mean average precision (mAP) ranging from 4.2% to 38.1%. This study also analyzes the significance of the results obtained by the presented approaches, performs a thorough methodological comparison between them, in-depth result analysis, and proposes a novel ensemble method for enhanced recognition. Our analysis shows that surgical workflow analysis is not yet solved, and also highlights interesting directions for future research on fine-grained surgical activity recognition which is of utmost importance for the development of AI in surgery.

Frequency-Supervised MR-to-CT Image Synthesis

This paper strives to generate a synthetic computed tomography (CT) image from a magnetic resonance (MR) image. The synthetic CT image is valuable for radiotherapy planning when only an MR image is available. Recent approaches have made large strides in solving this challenging synthesis problem with convolutional neural networks that learn a mapping from MR inputs to CT outputs. In this paper, we find that all existing approaches share a common limitation: reconstruction breaks down in and around the high-frequency parts of CT images. To address this common limitation, we introduce frequency-supervised deep networks to explicitly enhance high-frequency MR-to-CT image reconstruction. We propose a frequency decomposition layer that learns to decompose predicted CT outputs into low- and high-frequency components, and we introduce a refinement module to improve high-frequency reconstruction through high-frequency adversarial learning. Experimental results on a new dataset with 45 pairs of 3D MR-CT brain images show the effectiveness and potential of the proposed approach. Code is available at \url{https://github.com/shizenglin/Frequency-Supervised-MR-to-CT-Image-Synthesis}.

ICMSC: Intra- and Cross-modality Semantic Consistency for Unsupervised Domain Adaptation on Hip Joint Bone Segmentation

Unsupervised domain adaptation (UDA) for cross-modality medical image segmentation has shown great progress by domain-invariant feature learning or image appearance translation. Adapted feature learning usually cannot detect domain shifts at the pixel level and is not able to achieve good results in dense semantic segmentation tasks. Image appearance translation, e.g. CycleGAN, translates images into different styles with good appearance, despite its population, its semantic consistency is hardly to maintain and results in poor cross-modality segmentation. In this paper, we propose intra- and cross-modality semantic consistency (ICMSC) for UDA and our key insight is that the segmentation of synthesised images in different styles should be consistent. Specifically, our model consists of an image translation module and a domain-specific segmentation module. The image translation module is a standard CycleGAN, while the segmentation module contains two domain-specific segmentation networks. The intra-modality semantic consistency (IMSC) forces the reconstructed image after a cycle to be segmented in the same way as the original input image, while the cross-modality semantic consistency (CMSC) encourages the synthesized images after translation to be segmented exactly the same as before translation. Comprehensive experimental results on cross-modality hip joint bone segmentation show the effectiveness of our proposed method, which achieves an average DICE of 81.61% on the acetabulum and 88.16% on the proximal femur, outperforming other state-of-the-art methods. It is worth to note that without UDA, a model trained on CT for hip joint bone segmentation is non-transferable to MRI and has almost zero-DICE segmentation.

Robust Regression via Deep Negative Correlation Learning

Nonlinear regression has been extensively employed in many computer vision problems (e.g., crowd counting, age estimation, affective computing). Under the umbrella of deep learning, two common solutions exist i) transforming nonlinear regression to a robust loss function which is jointly optimizable with the deep convolutional network, and ii) utilizing ensemble of deep networks. Although some improved performance is achieved, the former may be lacking due to the intrinsic limitation of choosing a single hypothesis and the latter usually suffers from much larger computational complexity. To cope with those issues, we propose to regress via an efficient "divide and conquer" manner. The core of our approach is the generalization of negative correlation learning that has been shown, both theoretically and empirically, to work well for non-deep regression problems. Without extra parameters, the proposed method controls the bias-variance-covariance trade-off systematically and usually yields a deep regression ensemble where each base model is both "accurate" and "diversified". Moreover, we show that each sub-problem in the proposed method has less Rademacher Complexity and thus is easier to optimize. Extensive experiments on several diverse and challenging tasks including crowd counting, personality analysis, age estimation, and image super-resolution demonstrate the superiority over challenging baselines as well as the versatility of the proposed method.

Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. Automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their method on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge (https://wmh.isi.uu.nl/). Sixty T1+FLAIR images from three MR scanners were released with manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. Segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: (1) Dice similarity coefficient, (2) modified Hausdorff distance (95th percentile), (3) absolute log-transformed volume difference, (4) sensitivity for detecting individual lesions, and (5) F1-score for individual lesions. Additionally, methods were ranked on their inter-scanner robustness. Twenty participants submitted their method for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation.