3DPX: Single Panoramic X-ray Analysis Guided by 3D Oral Structure Reconstruction

Panoramic X-ray (PX) is a prevalent modality in dentistry practice owing to its wide availability and low cost. However, as a 2D projection of a 3D structure, PX suffers from anatomical information loss and PX diagnosis is limited compared to that with 3D imaging modalities. 2D-to-3D reconstruction methods have been explored for the ability to synthesize the absent 3D anatomical information from 2D PX for use in PX image analysis. However, there are challenges in leveraging such 3D synthesized reconstructions. First, inferring 3D depth from 2D images remains a challenging task with limited accuracy. The second challenge is the joint analysis of 2D PX with its 3D synthesized counterpart, with the aim to maximize the 2D-3D synergy while minimizing the errors arising from the synthesized image. In this study, we propose a new method termed 3DPX - PX image analysis guided by 2D-to-3D reconstruction, to overcome these challenges. 3DPX consists of (i) a novel progressive reconstruction network to improve 2D-to-3D reconstruction and, (ii) a contrastive-guided bidirectional multimodality alignment module for 3D-guided 2D PX classification and segmentation tasks. The reconstruction network progressively reconstructs 3D images with knowledge imposed on the intermediate reconstructions at multiple pyramid levels and incorporates Multilayer Perceptrons to improve semantic understanding. The downstream networks leverage the reconstructed images as 3D anatomical guidance to the PX analysis through feature alignment, which increases the 2D-3D synergy with bidirectional feature projection and decease the impact of potential errors with contrastive guidance. Extensive experiments on two oral datasets involving 464 studies demonstrate that 3DPX outperforms the state-of-the-art methods in various tasks including 2D-to-3D reconstruction, PX classification and lesion segmentation.

SGSeg: Enabling Text-free Inference in Language-guided Segmentation of Chest X-rays via Self-guidance

Segmentation of infected areas in chest X-rays is pivotal for facilitating the accurate delineation of pulmonary structures and pathological anomalies. Recently, multi-modal language-guided image segmentation methods have emerged as a promising solution for chest X-rays where the clinical text reports, depicting the assessment of the images, are used as guidance. Nevertheless, existing language-guided methods require clinical reports alongside the images, and hence, they are not applicable for use in image segmentation in a decision support context, but rather limited to retrospective image analysis after clinical reporting has been completed. In this study, we propose a self-guided segmentation framework (SGSeg) that leverages language guidance for training (multi-modal) while enabling text-free inference (uni-modal), which is the first that enables text-free inference in language-guided segmentation. We exploit the critical location information of both pulmonary and pathological structures depicted in the text reports and introduce a novel localization-enhanced report generation (LERG) module to generate clinical reports for self-guidance. Our LERG integrates an object detector and a location-based attention aggregator, weakly-supervised by a location-aware pseudo-label extraction module. Extensive experiments on a well-benchmarked QaTa-COV19 dataset demonstrate that our SGSeg achieved superior performance than existing uni-modal segmentation methods and closely matched the state-of-the-art performance of multi-modal language-guided segmentation methods.

3DPX: Progressive 2D-to-3D Oral Image Reconstruction with Hybrid MLP-CNN Networks

Panoramic X-ray (PX) is a prevalent modality in dental practice for its wide availability and low cost. However, as a 2D projection image, PX does not contain 3D anatomical information, and therefore has limited use in dental applications that can benefit from 3D information, e.g., tooth angular misa-lignment detection and classification. Reconstructing 3D structures directly from 2D PX has recently been explored to address limitations with existing methods primarily reliant on Convolutional Neural Networks (CNNs) for direct 2D-to-3D mapping. These methods, however, are unable to correctly infer depth-axis spatial information. In addition, they are limited by the in-trinsic locality of convolution operations, as the convolution kernels only capture the information of immediate neighborhood pixels. In this study, we propose a progressive hybrid Multilayer Perceptron (MLP)-CNN pyra-mid network (3DPX) for 2D-to-3D oral PX reconstruction. We introduce a progressive reconstruction strategy, where 3D images are progressively re-constructed in the 3DPX with guidance imposed on the intermediate recon-struction result at each pyramid level. Further, motivated by the recent ad-vancement of MLPs that show promise in capturing fine-grained long-range dependency, our 3DPX integrates MLPs and CNNs to improve the semantic understanding during reconstruction. Extensive experiments on two large datasets involving 464 studies demonstrate that our 3DPX outperforms state-of-the-art 2D-to-3D oral reconstruction methods, including standalone MLP and transformers, in reconstruction quality, and also im-proves the performance of downstream angular misalignment classification tasks.

GVT2RPM: An Empirical Study for General Video Transformer Adaptation to Remote Physiological Measurement

Remote physiological measurement (RPM) is an essential tool for healthcare monitoring as it enables the measurement of physiological signs, e.g., heart rate, in a remote setting via physical wearables. Recently, with facial videos, we have seen rapid advancements in video-based RPMs. However, adopting facial videos for RPM in the clinical setting largely depends on the accuracy and robustness (work across patient populations). Fortunately, the capability of the state-of-the-art transformer architecture in general (natural) video understanding has resulted in marked improvements and has been translated to facial understanding, including RPM. However, existing RPM methods usually need RPM-specific modules, e.g., temporal difference convolution and handcrafted feature maps. Although these customized modules can increase accuracy, they are not demonstrated for their robustness across datasets. Further, due to their customization of the transformer architecture, they cannot use the advancements made in general video transformers (GVT). In this study, we interrogate the GVT architecture and empirically analyze how the training designs, i.e., data pre-processing and network configurations, affect the model performance applied to RPM. Based on the structure of video transformers, we propose to configure its spatiotemporal hierarchy to align with the dense temporal information needed in RPM for signal feature extraction. We define several practical guidelines and gradually adapt GVTs for RPM without introducing RPM-specific modules. Our experiments demonstrate favorable results to existing RPM-specific module counterparts. We conducted extensive experiments with five datasets using intra-dataset and cross-dataset settings. We highlight that the proposed guidelines GVT2RPM can be generalized to any video transformers and is robust to various datasets.

Correlation-aware Coarse-to-fine MLPs for Deformable Medical Image Registration

Deformable image registration is a fundamental step for medical image analysis. Recently, transformers have been used for registration and outperformed Convolutional Neural Networks (CNNs). Transformers can capture long-range dependence among image features, which have been shown beneficial for registration. However, due to the high computation/memory loads of self-attention, transformers are typically used at downsampled feature resolutions and cannot capture fine-grained long-range dependence at the full image resolution. This limits deformable registration as it necessitates precise dense correspondence between each image pixel. Multi-layer Perceptrons (MLPs) without self-attention are efficient in computation/memory usage, enabling the feasibility of capturing fine-grained long-range dependence at full resolution. Nevertheless, MLPs have not been extensively explored for image registration and are lacking the consideration of inductive bias crucial for medical registration tasks. In this study, we propose the first correlation-aware MLP-based registration network (CorrMLP) for deformable medical image registration. Our CorrMLP introduces a correlation-aware multi-window MLP block in a novel coarse-to-fine registration architecture, which captures fine-grained multi-range dependence to perform correlation-aware coarse-to-fine registration. Extensive experiments with seven public medical datasets show that our CorrMLP outperforms state-of-the-art deformable registration methods.

Dual-modal Dynamic Traceback Learning for Medical Report Generation

With increasing reliance on medical imaging in clinical practices, automated report generation from medical images is in great demand. Existing report generation methods typically adopt an encoder-decoder deep learning framework to build a uni-directional image-to-report mapping. However, such a framework ignores the bi-directional mutual associations between images and reports, thus incurring difficulties in associating the intrinsic medical meanings between them. Recent generative representation learning methods have demonstrated the benefits of dual-modal learning from both image and text modalities. However, these methods exhibit two major drawbacks for medical report generation: 1) they tend to capture morphological information and have difficulties in capturing subtle pathological semantic information, and 2) they predict masked text rely on both unmasked images and text, inevitably degrading performance when inference is based solely on images. In this study, we propose a new report generation framework with dual-modal dynamic traceback learning (DTrace) to overcome the two identified drawbacks and enable dual-modal learning for medical report generation. To achieve this, our DTrace introduces a traceback mechanism to control the semantic validity of generated content via self-assessment. Further, our DTrace introduces a dynamic learning strategy to adapt to various proportions of image and text input, enabling report generation without reliance on textual input during inference. Extensive experiments on two well-benchmarked datasets (IU-Xray and MIMIC-CXR) show that our DTrace outperforms state-of-the-art medical report generation methods.

Enhancing medical vision-language contrastive learning via inter-matching relation modelling

Medical image representations can be learned through medical vision-language contrastive learning (mVLCL) where medical imaging reports are used as weak supervision through image-text alignment. These learned image representations can be transferred to and benefit various downstream medical vision tasks such as disease classification and segmentation. Recent mVLCL methods attempt to align image sub-regions and the report keywords as local-matchings. However, these methods aggregate all local-matchings via simple pooling operations while ignoring the inherent relations between them. These methods therefore fail to reason between local-matchings that are semantically related, e.g., local-matchings that correspond to the disease word and the location word (semantic-relations), and also fail to differentiate such clinically important local-matchings from others that correspond to less meaningful words, e.g., conjunction words (importance-relations). Hence, we propose a mVLCL method that models the inter-matching relations between local-matchings via a relation-enhanced contrastive learning framework (RECLF). In RECLF, we introduce a semantic-relation reasoning module (SRM) and an importance-relation reasoning module (IRM) to enable more fine-grained report supervision for image representation learning. We evaluated our method using four public benchmark datasets on four downstream tasks, including segmentation, zero-shot classification, supervised classification, and cross-modal retrieval. Our results demonstrated the superiority of our RECLF over the state-of-the-art mVLCL methods with consistent improvements across single-modal and cross-modal tasks. These results suggest that our RECLF, by modelling the inter-matching relations, can learn improved medical image representations with better generalization capabilities.

Full-resolution MLPs Empower Medical Dense Prediction

Dense prediction is a fundamental requirement for many medical vision tasks such as medical image restoration, registration, and segmentation. The most popular vision model, Convolutional Neural Networks (CNNs), has reached bottlenecks due to the intrinsic locality of convolution operations. Recently, transformers have been widely adopted for dense prediction for their capability to capture long-range visual dependence. However, due to the high computational complexity and large memory consumption of self-attention operations, transformers are usually used at downsampled feature resolutions. Such usage cannot effectively leverage the tissue-level textural information available only at the full image resolution. This textural information is crucial for medical dense prediction as it can differentiate the subtle human anatomy in medical images. In this study, we hypothesize that Multi-layer Perceptrons (MLPs) are superior alternatives to transformers in medical dense prediction where tissue-level details dominate the performance, as MLPs enable long-range dependence at the full image resolution. To validate our hypothesis, we develop a full-resolution hierarchical MLP framework that uses MLPs beginning from the full image resolution. We evaluate this framework with various MLP blocks on a wide range of medical dense prediction tasks including restoration, registration, and segmentation. Extensive experiments on six public well-benchmarked datasets show that, by simply using MLPs at full resolution, our framework outperforms its CNN and transformer counterparts and achieves state-of-the-art performance on various medical dense prediction tasks.

Self-Supervised Multi-Modality Learning for Multi-Label Skin Lesion Classification

The clinical diagnosis of skin lesion involves the analysis of dermoscopic and clinical modalities. Dermoscopic images provide a detailed view of the surface structures whereas clinical images offer a complementary macroscopic information. The visual diagnosis of melanoma is also based on seven-point checklist which involves identifying different visual attributes. Recently, supervised learning approaches such as convolutional neural networks (CNNs) have shown great performances using both dermoscopic and clinical modalities (Multi-modality). The seven different visual attributes in the checklist are also used to further improve the the diagnosis. The performances of these approaches, however, are still reliant on the availability of large-scaled labeled data. The acquisition of annotated dataset is an expensive and time-consuming task, more so with annotating multi-attributes. To overcome this limitation, we propose a self-supervised learning (SSL) algorithm for multi-modality skin lesion classification. Our algorithm enables the multi-modality learning by maximizing the similarities between paired dermoscopic and clinical images from different views. In addition, we generate surrogate pseudo-multi-labels that represent seven attributes via clustering analysis. We also propose a label-relation-aware module to refine each pseudo-label embedding and capture the interrelationships between pseudo-multi-labels. We validated the effectiveness of our algorithm using well-benchmarked seven-point skin lesion dataset. Our results show that our algorithm achieved better performances than other state-of-the-art SSL counterparts.

PET Synthesis via Self-supervised Adaptive Residual Estimation Generative Adversarial Network

Positron emission tomography (PET) is a widely used, highly sensitive molecular imaging in clinical diagnosis. There is interest in reducing the radiation exposure from PET but also maintaining adequate image quality. Recent methods using convolutional neural networks (CNNs) to generate synthesized high-quality PET images from low-dose counterparts have been reported to be state-of-the-art for low-to-high image recovery methods. However, these methods are prone to exhibiting discrepancies in texture and structure between synthesized and real images. Furthermore, the distribution shift between low-dose PET and standard PET has not been fully investigated. To address these issues, we developed a self-supervised adaptive residual estimation generative adversarial network (SS-AEGAN). We introduce (1) An adaptive residual estimation mapping mechanism, AE-Net, designed to dynamically rectify the preliminary synthesized PET images by taking the residual map between the low-dose PET and synthesized output as the input, and (2) A self-supervised pre-training strategy to enhance the feature representation of the coarse generator. Our experiments with a public benchmark dataset of total-body PET images show that SS-AEGAN consistently outperformed the state-of-the-art synthesis methods with various dose reduction factors.