Multi-rater Prompting for Ambiguous Medical Image Segmentation

Multi-rater annotations commonly occur when medical images are independently annotated by multiple experts (raters). In this paper, we tackle two challenges arisen in multi-rater annotations for medical image segmentation (called ambiguous medical image segmentation): (1) How to train a deep learning model when a group of raters produces a set of diverse but plausible annotations, and (2) how to fine-tune the model efficiently when computation resources are not available for re-training the entire model on a different dataset domain. We propose a multi-rater prompt-based approach to address these two challenges altogether. Specifically, we introduce a series of rater-aware prompts that can be plugged into the U-Net model for uncertainty estimation to handle multi-annotation cases. During the prompt-based fine-tuning process, only 0.3% of learnable parameters are required to be updated comparing to training the entire model. Further, in order to integrate expert consensus and disagreement, we explore different multi-rater incorporation strategies and design a mix-training strategy for comprehensive insight learning. Extensive experiments verify the effectiveness of our new approach for ambiguous medical image segmentation on two public datasets while alleviating the heavy burden of model re-training.

PoCo: A Self-Supervised Approach via Polar Transformation Based Progressive Contrastive Learning for Ophthalmic Disease Diagnosis

Automatic ophthalmic disease diagnosis on fundus images is important in clinical practice. However, due to complex fundus textures and limited annotated data, developing an effective automatic method for this problem is still challenging. In this paper, we present a self-supervised method via polar transformation based progressive contrastive learning, called PoCo, for ophthalmic disease diagnosis. Specifically, we novelly inject the polar transformation into contrastive learning to 1) promote contrastive learning pre-training to be faster and more stable and 2) naturally capture task-free and rotation-related textures, which provides insights into disease recognition on fundus images. Beneficially, simple normal translation-invariant convolution on transformed images can equivalently replace the complex rotation-invariant and sector convolution on raw images. After that, we develop a progressive contrastive learning method to efficiently utilize large unannotated images and a novel progressive hard negative sampling scheme to gradually reduce the negative sample number for efficient training and performance enhancement. Extensive experiments on three public ophthalmic disease datasets show that our PoCo achieves state-of-the-art performance with good generalization ability, validating that our method can reduce annotation efforts and provide reliable diagnosis. Codes are available at \url{https://github.com/wjh892521292/PoCo}.

Large Window-based Mamba UNet for Medical Image Segmentation: Beyond Convolution and Self-attention

In clinical practice, medical image segmentation provides useful information on the contours and dimensions of target organs or tissues, facilitating improved diagnosis, analysis, and treatment. In the past few years, convolutional neural networks (CNNs) and Transformers have dominated this area, but they still suffer from either limited receptive fields or costly long-range modeling. Mamba, a State Space Sequence Model (SSM), recently emerged as a promising paradigm for long-range dependency modeling with linear complexity. In this paper, we introduce a Large Window-based Mamba U}-shape Network, or LMa-UNet, for 2D and 3D medical image segmentation. A distinguishing feature of our LMa-UNet is its utilization of large windows, excelling in locally spatial modeling compared to small kernel-based CNNs and small window-based Transformers, while maintaining superior efficiency in global modeling compared to self-attention with quadratic complexity. Additionally, we design a novel hierarchical and bidirectional Mamba block to further enhance the global and neighborhood spatial modeling capability of Mamba. Comprehensive experiments demonstrate the effectiveness and efficiency of our method and the feasibility of using large window size to achieve large receptive fields. Codes are available at https://github.com/wjh892521292/LMa-UNet.

Jointly Explicit and Implicit Cross-Modal Interaction Network for Anterior Chamber Inflammation Diagnosis

Uveitis demands the precise diagnosis of anterior chamber inflammation (ACI) for optimal treatment. However, current diagnostic methods only rely on a limited single-modal disease perspective, which leads to poor performance. In this paper, we investigate a promising yet challenging way to fuse multimodal data for ACI diagnosis. Notably, existing fusion paradigms focus on empowering implicit modality interactions (i.e., self-attention and its variants), but neglect to inject explicit modality interactions, especially from clinical knowledge and imaging property. To this end, we propose a jointly Explicit and implicit Cross-Modal Interaction Network (EiCI-Net) for Anterior Chamber Inflammation Diagnosis that uses anterior segment optical coherence tomography (AS-OCT) images, slit-lamp images, and clinical data jointly. Specifically, we first develop CNN-Based Encoders and Tabular Processing Module (TPM) to extract efficient feature representations in different modalities. Then, we devise an Explicit Cross-Modal Interaction Module (ECIM) to generate attention maps as a kind of explicit clinical knowledge based on the tabular feature maps, then integrated them into the slit-lamp feature maps, allowing the CNN-Based Encoder to focus on more effective informativeness of the slit-lamp images. After that, the Implicit Cross-Modal Interaction Module (ICIM), a transformer-based network, further implicitly enhances modality interactions. Finally, we construct a considerable real-world dataset from our collaborative hospital and conduct sufficient experiments to demonstrate the superior performance of our proposed EiCI-Net compared with the state-of-the-art classification methods in various metrics.

Ord2Seq: Regarding Ordinal Regression as Label Sequence Prediction

Ordinal regression refers to classifying object instances into ordinal categories. It has been widely studied in many scenarios, such as medical disease grading, movie rating, etc. Known methods focused only on learning inter-class ordinal relationships, but still incur limitations in distinguishing adjacent categories thus far. In this paper, we propose a simple sequence prediction framework for ordinal regression called Ord2Seq, which, for the first time, transforms each ordinal category label into a special label sequence and thus regards an ordinal regression task as a sequence prediction process. In this way, we decompose an ordinal regression task into a series of recursive binary classification steps, so as to subtly distinguish adjacent categories. Comprehensive experiments show the effectiveness of distinguishing adjacent categories for performance improvement and our new approach exceeds state-of-the-art performances in four different scenarios. Codes are available at https://github.com/wjh892521292/Ord2Seq.

Ord2Seq: Regard Ordinal Regression as Label Sequence Prediction

Ordinal regression refers to classifying object instances into ordinal categories. It has been widely studied in many scenarios, such as medical disease grading, movie rating, etc. Known methods focused only on learning inter-class ordinal relationships, but still incur limitations in distinguishing adjacent categories thus far. In this paper, we propose a simple sequence prediction framework for ordinal regression called Ord2Seq, which, for the first time, transforms each ordinal category label into a special label sequence and thus regards an ordinal regression task as a sequence prediction process. In this way, we decompose an ordinal regression task into a series of recursive binary classification steps, so as to subtly distinguish adjacent categories. Comprehensive experiments show the effectiveness of distinguishing adjacent categories for performance improvement and our new approach exceeds state-of-the-art performances in four different scenarios. Codes will be available upon acceptance.

Robust Image Ordinal Regression with Controllable Image Generation

Image ordinal regression has been mainly studied along the line of exploiting the order of categories. However, the issues of class imbalance and category overlap that are very common in ordinal regression were largely overlooked. As a result, the performance on minority categories is often unsatisfactory. In this paper, we propose a novel framework called CIG based on controllable image generation to directly tackle these two issues. Our main idea is to generate extra training samples with specific labels near category boundaries, and the sample generation is biased toward the less-represented categories. To achieve controllable image generation, we seek to separate structural and categorical information of images based on structural similarity, categorical similarity, and reconstruction constraints. We evaluate the effectiveness of our new CIG approach in three different image ordinal regression scenarios. The results demonstrate that CIG can be flexibly integrated with off-the-shelf image encoders or ordinal regression models to achieve improvement, and further, the improvement is more significant for minority categories.

CTT-Net: A Multi-view Cross-token Transformer for Cataract Postoperative Visual Acuity Prediction

Surgery is the only viable treatment for cataract patients with visual acuity (VA) impairment. Clinically, to assess the necessity of cataract surgery, accurately predicting postoperative VA before surgery by analyzing multi-view optical coherence tomography (OCT) images is crucially needed. Unfortunately, due to complicated fundus conditions, determining postoperative VA remains difficult for medical experts. Deep learning methods for this problem were developed in recent years. Although effective, these methods still face several issues, such as not efficiently exploring potential relations between multi-view OCT images, neglecting the key role of clinical prior knowledge (e.g., preoperative VA value), and using only regression-based metrics which are lacking reference. In this paper, we propose a novel Cross-token Transformer Network (CTT-Net) for postoperative VA prediction by analyzing both the multi-view OCT images and preoperative VA. To effectively fuse multi-view features of OCT images, we develop cross-token attention that could restrict redundant/unnecessary attention flow. Further, we utilize the preoperative VA value to provide more information for postoperative VA prediction and facilitate fusion between views. Moreover, we design an auxiliary classification loss to improve model performance and assess VA recovery more sufficiently, avoiding the limitation by only using the regression metrics. To evaluate CTT-Net, we build a multi-view OCT image dataset collected from our collaborative hospital. A set of extensive experiments validate the effectiveness of our model compared to existing methods in various metrics. Code is available at: https://github.com/wjh892521292/Cataract OCT.

D-Former: A U-shaped Dilated Transformer for 3D Medical Image Segmentation

Computer-aided medical image segmentation has been applied widely in diagnosis and treatment to obtain clinically useful information of shapes and volumes of target organs and tissues. In the past several years, convolutional neural network (CNN) based methods (e.g., U-Net) have dominated this area, but still suffered from inadequate long-range information capturing. Hence, recent work presented computer vision Transformer variants for medical image segmentation tasks and obtained promising performances. Such Transformers model long-range dependency by computing pair-wise patch relations. However, they incur prohibitive computational costs, especially on 3D medical images (e.g., CT and MRI). In this paper, we propose a new method called Dilated Transformer, which conducts self-attention for pair-wise patch relations captured alternately in local and global scopes. Inspired by dilated convolution kernels, we conduct the global self-attention in a dilated manner, enlarging receptive fields without increasing the patches involved and thus reducing computational costs. Based on this design of Dilated Transformer, we construct a U-shaped encoder-decoder hierarchical architecture called D-Former for 3D medical image segmentation. Experiments on the Synapse and ACDC datasets show that our D-Former model, trained from scratch, outperforms various competitive CNN-based or Transformer-based segmentation models at a low computational cost without time-consuming per-training process.