Handheld ultrasound devices face usage limitations due to user inexperience and cannot benefit from supervised deep learning without extensive expert annotations. Moreover, the models trained on standard ultrasound device data are constrained by training data distribution and perform poorly when directly applied to handheld device data. In this study, we propose the Training-free Image Style Alignment (TISA) framework to align the style of handheld device data to those of standard devices. The proposed TISA can directly infer handheld device images without extra training and is suited for clinical applications. We show that TISA performs better and more stably in medical detection and segmentation tasks for handheld device data. We further validate TISA as the clinical model for automatic measurements of spinal curvature and carotid intima-media thickness. The automatic measurements agree well with manual measurements made by human experts and the measurement errors remain within clinically acceptable ranges. We demonstrate the potential for TISA to facilitate automatic diagnosis on handheld ultrasound devices and expedite their eventual widespread use.
Frontotemporal Dementia (FTD) diagnosis has been successfully progress using deep learning techniques. However, current FTD identification methods suffer from two limitations. Firstly, they do not exploit the potential of multi-view functional magnetic resonance imaging (fMRI) for classifying FTD. Secondly, they do not consider the reliability of the multi-view FTD diagnosis. To address these limitations, we propose a reliable multi-view impartial decision network (MID-Net) for FTD diagnosis in fMRI. Our MID-Net provides confidence for each view and generates a reliable prediction without any conflict. To achieve this, we employ multiple expert models to extract evidence from the abundant neural network information contained in fMRI images. We then introduce the Dirichlet Distribution to characterize the expert class probability distribution from an evidence level. Additionally, a novel Impartial Decision Maker (IDer) is proposed to combine the different opinions inductively to arrive at an unbiased prediction without additional computation cost. Overall, our MID-Net dynamically integrates the decisions of different experts on FTD disease, especially when dealing with multi-view high-conflict cases. Extensive experiments on a high-quality FTD fMRI dataset demonstrate that our model outperforms previous methods and provides high uncertainty for hard-to-classify examples. We believe that our approach represents a significant step toward the deployment of reliable FTD decision-making under multi-expert conditions. We will release the codes for reproduction after acceptance.
Recently, Segmenting Anything has taken an important step towards general artificial intelligence. At the same time, its reliability and fairness have also attracted great attention, especially in the field of health care. In this study, we propose multi-box prompts triggered uncertainty estimation for SAM cues to demonstrate the reliability of segmented lesions or tissues. We estimate the distribution of SAM predictions via Monte Carlo with prior distribution parameters, which employs different prompts as formulation of test-time augmentation. Our experimental results found that multi-box prompts augmentation improve the SAM performance, and endowed each pixel with uncertainty. This provides the first paradigm for a reliable SAM.
Failure to recognize samples from the classes unseen during training is a major limit of artificial intelligence (AI) in real-world implementation of retinal anomaly classification. To resolve this obstacle, we propose an uncertainty-inspired open-set (UIOS) model which was trained with fundus images of 9 common retinal conditions. Besides the probability of each category, UIOS also calculates an uncertainty score to express its confidence. Our UIOS model with thresholding strategy achieved an F1 score of 99.55%, 97.01% and 91.91% for the internal testing set, external testing set and non-typical testing set, respectively, compared to the F1 score of 92.20%, 80.69% and 64.74% by the standard AI model. Furthermore, UIOS correctly predicted high uncertainty scores, which prompted the need for a manual check, in the datasets of rare retinal diseases, low-quality fundus images, and non-fundus images. This work provides a robust method for real-world screening of retinal anomalies.
Classification and segmentation are crucial in medical image analysis as they enable accurate diagnosis and disease monitoring. However, current methods often prioritize the mutual learning features and shared model parameters, while neglecting the reliability of features and performances. In this paper, we propose a novel Uncertainty-informed Mutual Learning (UML) framework for reliable and interpretable medical image analysis. Our UML introduces reliability to joint classification and segmentation tasks, leveraging mutual learning with uncertainty to improve performance. To achieve this, we first use evidential deep learning to provide image-level and pixel-wise confidences. Then, an Uncertainty Navigator Decoder is constructed for better using mutual features and generating segmentation results. Besides, an Uncertainty Instructor is proposed to screen reliable masks for classification. Overall, UML could produce confidence estimation in features and performance for each link (classification and segmentation). The experiments on the public datasets demonstrate that our UML outperforms existing methods in terms of both accuracy and robustness. Our UML has the potential to explore the development of more reliable and explainable medical image analysis models. We will release the codes for reproduction after acceptance.
Deep learning models have shown promising performance in the field of diabetic retinopathy (DR) staging. However, collaboratively training a DR staging model across multiple institutions remains a challenge due to non-iid data, client reliability, and confidence evaluation of the prediction. To address these issues, we propose a novel federated uncertainty-aware aggregation paradigm (FedUAA), which considers the reliability of each client and produces a confidence estimation for the DR staging. In our FedUAA, an aggregated encoder is shared by all clients for learning a global representation of fundus images, while a novel temperature-warmed uncertainty head (TWEU) is utilized for each client for local personalized staging criteria. Our TWEU employs an evidential deep layer to produce the uncertainty score with the DR staging results for client reliability evaluation. Furthermore, we developed a novel uncertainty-aware weighting module (UAW) to dynamically adjust the weights of model aggregation based on the uncertainty score distribution of each client. In our experiments, we collect five publicly available datasets from different institutions to conduct a dataset for federated DR staging to satisfy the real non-iid condition. The experimental results demonstrate that our FedUAA achieves better DR staging performance with higher reliability compared to other federated learning methods. Our proposed FedUAA paradigm effectively addresses the challenges of collaboratively training DR staging models across multiple institutions, and provides a robust and reliable solution for the deployment of DR diagnosis models in real-world clinical scenarios.
Multimodality eye disease screening is crucial in ophthalmology as it integrates information from diverse sources to complement their respective performances. However, the existing methods are weak in assessing the reliability of each unimodality, and directly fusing an unreliable modality may cause screening errors. To address this issue, we introduce a novel multimodality evidential fusion pipeline for eye disease screening, EyeMoS$t$, which provides a measure of confidence for unimodality and elegantly integrates the multimodality information from a multi-distribution fusion perspective. Specifically, our model estimates both local uncertainty for unimodality and global uncertainty for the fusion modality to produce reliable classification results. More importantly, the proposed mixture of Student's $t$ distributions adaptively integrates different modalities to endow the model with heavy-tailed properties, increasing robustness and reliability. Our experimental findings on both public and in-house datasets show that our model is more reliable than current methods. Additionally, EyeMos$t$ has the potential ability to serve as a data quality discriminator, enabling reliable decision-making for multimodality eye disease screening.
The use of AI systems in healthcare for the early screening of diseases is of great clinical importance. Deep learning has shown great promise in medical imaging, but the reliability and trustworthiness of AI systems limit their deployment in real clinical scenes, where patient safety is at stake. Uncertainty estimation plays a pivotal role in producing a confidence evaluation along with the prediction of the deep model. This is particularly important in medical imaging, where the uncertainty in the model's predictions can be used to identify areas of concern or to provide additional information to the clinician. In this paper, we review the various types of uncertainty in deep learning, including aleatoric uncertainty, epistemic uncertainty, and out-of-distribution uncertainty, and we discuss how they can be estimated in medical imaging. We also review recent advances in deep learning models that incorporate uncertainty estimation in medical imaging. Finally, we discuss the challenges and future directions in uncertainty estimation in deep learning for medical imaging. We hope this review will ignite further interest in the community and provide researchers with an up-to-date reference regarding applications of uncertainty estimation models in medical imaging.
Federated learning (FL), as an effective decentralized distributed learning approach, enables multiple institutions to jointly train a model without sharing their local data. However, the domain feature shift caused by different acquisition devices/clients substantially degrades the performance of the FL model. Furthermore, most existing FL approaches aim to improve accuracy without considering reliability (e.g., confidence or uncertainty). The predictions are thus unreliable when deployed in safety-critical applications. Therefore, aiming at improving the performance of FL in non-Domain feature issues while enabling the model more reliable. In this paper, we propose a novel trusted federated disentangling network, termed TrFedDis, which utilizes feature disentangling to enable the ability to capture the global domain-invariant cross-client representation and preserve local client-specific feature learning. Meanwhile, to effectively integrate the decoupled features, an uncertainty-aware decision fusion is also introduced to guide the network for dynamically integrating the decoupled features at the evidence level, while producing a reliable prediction with an estimated uncertainty. To the best of our knowledge, our proposed TrFedDis is the first work to develop an FL approach based on evidential uncertainty combined with feature disentangling, which enhances the performance and reliability of FL in non-IID domain features. Extensive experimental results show that our proposed TrFedDis provides outstanding performance with a high degree of reliability as compared to other state-of-the-art FL approaches.