Rethinking Self-training for Semi-supervised Landmark Detection: A Selection-free Approach

Self-training is a simple yet effective method for semi-supervised learning, during which pseudo-label selection plays an important role for handling confirmation bias. Despite its popularity, applying self-training to landmark detection faces three problems: 1) The selected confident pseudo-labels often contain data bias, which may hurt model performance; 2) It is not easy to decide a proper threshold for sample selection as the localization task can be sensitive to noisy pseudo-labels; 3) coordinate regression does not output confidence, making selection-based self-training infeasible. To address the above issues, we propose Self-Training for Landmark Detection (STLD), a method that does not require explicit pseudo-label selection. Instead, STLD constructs a task curriculum to deal with confirmation bias, which progressively transitions from more confident to less confident tasks over the rounds of self-training. Pseudo pretraining and shrink regression are two essential components for such a curriculum, where the former is the first task of the curriculum for providing a better model initialization and the latter is further added in the later rounds to directly leverage the pseudo-labels in a coarse-to-fine manner. Experiments on three facial and one medical landmark detection benchmark show that STLD outperforms the existing methods consistently in both semi- and omni-supervised settings.

Unpaired Optical Coherence Tomography Angiography Image Super-Resolution via Frequency-Aware Inverse-Consistency GAN

For optical coherence tomography angiography (OCTA) images, a limited scanning rate leads to a trade-off between field-of-view (FOV) and imaging resolution. Although larger FOV images may reveal more parafoveal vascular lesions, their application is greatly hampered due to lower resolution. To increase the resolution, previous works only achieved satisfactory performance by using paired data for training, but real-world applications are limited by the challenge of collecting large-scale paired images. Thus, an unpaired approach is highly demanded. Generative Adversarial Network (GAN) has been commonly used in the unpaired setting, but it may struggle to accurately preserve fine-grained capillary details, which are critical biomarkers for OCTA. In this paper, our approach aspires to preserve these details by leveraging the frequency information, which represents details as high-frequencies ($\textbf{hf}$) and coarse-grained backgrounds as low-frequencies ($\textbf{lf}$). In general, we propose a GAN-based unpaired super-resolution method for OCTA images and exceptionally emphasize $\textbf{hf}$ fine capillaries through a dual-path generator. To facilitate a precise spectrum of the reconstructed image, we also propose a frequency-aware adversarial loss for the discriminator and introduce a frequency-aware focal consistency loss for end-to-end optimization. Experiments show that our method outperforms other state-of-the-art unpaired methods both quantitatively and visually.

Unsupervised Domain Adaptation for Anatomical Landmark Detection

Recently, anatomical landmark detection has achieved great progresses on single-domain data, which usually assumes training and test sets are from the same domain. However, such an assumption is not always true in practice, which can cause significant performance drop due to domain shift. To tackle this problem, we propose a novel framework for anatomical landmark detection under the setting of unsupervised domain adaptation (UDA), which aims to transfer the knowledge from labeled source domain to unlabeled target domain. The framework leverages self-training and domain adversarial learning to address the domain gap during adaptation. Specifically, a self-training strategy is proposed to select reliable landmark-level pseudo-labels of target domain data with dynamic thresholds, which makes the adaptation more effective. Furthermore, a domain adversarial learning module is designed to handle the unaligned data distributions of two domains by learning domain-invariant features via adversarial training. Our experiments on cephalometric and lung landmark detection show the effectiveness of the method, which reduces the domain gap by a large margin and outperforms other UDA methods consistently. The code is available at https://github.com/jhb86253817/UDA_Med_Landmark.

PromptMRG: Diagnosis-Driven Prompts for Medical Report Generation

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

Towards Generalizable Diabetic Retinopathy Grading in Unseen Domains

Diabetic Retinopathy (DR) is a common complication of diabetes and a leading cause of blindness worldwide. Early and accurate grading of its severity is crucial for disease management. Although deep learning has shown great potential for automated DR grading, its real-world deployment is still challenging due to distribution shifts among source and target domains, known as the domain generalization problem. Existing works have mainly attributed the performance degradation to limited domain shifts caused by simple visual discrepancies, which cannot handle complex real-world scenarios. Instead, we present preliminary evidence suggesting the existence of three-fold generalization issues: visual and degradation style shifts, diagnostic pattern diversity, and data imbalance. To tackle these issues, we propose a novel unified framework named Generalizable Diabetic Retinopathy Grading Network (GDRNet). GDRNet consists of three vital components: fundus visual-artifact augmentation (FundusAug), dynamic hybrid-supervised loss (DahLoss), and domain-class-aware re-balancing (DCR). FundusAug generates realistic augmented images via visual transformation and image degradation, while DahLoss jointly leverages pixel-level consistency and image-level semantics to capture the diverse diagnostic patterns and build generalizable feature representations. Moreover, DCR mitigates the data imbalance from a domain-class view and avoids undesired over-emphasis on rare domain-class pairs. Finally, we design a publicly available benchmark for fair evaluations. Extensive comparison experiments against advanced methods and exhaustive ablation studies demonstrate the effectiveness and generalization ability of GDRNet.

Image Quality-aware Diagnosis via Meta-knowledge Co-embedding

Medical images usually suffer from image degradation in clinical practice, leading to decreased performance of deep learning-based models. To resolve this problem, most previous works have focused on filtering out degradation-causing low-quality images while ignoring their potential value for models. Through effectively learning and leveraging the knowledge of degradations, models can better resist their adverse effects and avoid misdiagnosis. In this paper, we raise the problem of image quality-aware diagnosis, which aims to take advantage of low-quality images and image quality labels to achieve a more accurate and robust diagnosis. However, the diversity of degradations and superficially unrelated targets between image quality assessment and disease diagnosis makes it still quite challenging to effectively leverage quality labels to assist diagnosis. Thus, to tackle these issues, we propose a novel meta-knowledge co-embedding network, consisting of two subnets: Task Net and Meta Learner. Task Net constructs an explicit quality information utilization mechanism to enhance diagnosis via knowledge co-embedding features, while Meta Learner ensures the effectiveness and constrains the semantics of these features via meta-learning and joint-encoding masking. Superior performance on five datasets with four widely-used medical imaging modalities demonstrates the effectiveness and generalizability of our method.

DRAC: Diabetic Retinopathy Analysis Challenge with Ultra-Wide Optical Coherence Tomography Angiography Images

Computer-assisted automatic analysis of diabetic retinopathy (DR) is of great importance in reducing the risks of vision loss and even blindness. Ultra-wide optical coherence tomography angiography (UW-OCTA) is a non-invasive and safe imaging modality in DR diagnosis system, but there is a lack of publicly available benchmarks for model development and evaluation. To promote further research and scientific benchmarking for diabetic retinopathy analysis using UW-OCTA images, we organized a challenge named "DRAC - Diabetic Retinopathy Analysis Challenge" in conjunction with the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2022). The challenge consists of three tasks: segmentation of DR lesions, image quality assessment and DR grading. The scientific community responded positively to the challenge, with 11, 12, and 13 teams from geographically diverse institutes submitting different solutions in these three tasks, respectively. This paper presents a summary and analysis of the top-performing solutions and results for each task of the challenge. The obtained results from top algorithms indicate the importance of data augmentation, model architecture and ensemble of networks in improving the performance of deep learning models. These findings have the potential to enable new developments in diabetic retinopathy analysis. The challenge remains open for post-challenge registrations and submissions for benchmarking future methodology developments.

Learning Robust Representation for Joint Grading of Ophthalmic Diseases via Adaptive Curriculum and Feature Disentanglement

Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of permanent blindness worldwide. Designing an automatic grading system with good generalization ability for DR and DME is vital in clinical practice. However, prior works either grade DR or DME independently, without considering internal correlations between them, or grade them jointly by shared feature representation, yet ignoring potential generalization issues caused by difficult samples and data bias. Aiming to address these problems, we propose a framework for joint grading with the dynamic difficulty-aware weighted loss (DAW) and the dual-stream disentangled learning architecture (DETACH). Inspired by curriculum learning, DAW learns from simple samples to difficult samples dynamically via measuring difficulty adaptively. DETACH separates features of grading tasks to avoid potential emphasis on the bias. With the addition of DAW and DETACH, the model learns robust disentangled feature representations to explore internal correlations between DR and DME and achieve better grading performance. Experiments on three benchmarks show the effectiveness and robustness of our framework under both the intra-dataset and cross-dataset tests.