Unsupervised Decomposition Networks for Bias Field Correction in MR Image

Bias field, which is caused by imperfect MR devices or imaged objects, introduces intensity inhomogeneity into MR images and degrades the performance of MR image analysis methods. Many retrospective algorithms were developed to facilitate the bias correction, to which the deep learning-based methods outperformed. However, in the training phase, the supervised deep learning-based methods heavily rely on the synthesized bias field. As the formation of the bias field is extremely complex, it is difficult to mimic the true physical property of MR images by synthesized data. While bias field correction and image segmentation are strongly related, the segmentation map is precisely obtained by decoupling the bias field from the original MR image, and the bias value is indicated by the segmentation map in reverse. Thus, we proposed novel unsupervised decomposition networks that are trained only with biased data to obtain the bias-free MR images. Networks are made up of: a segmentation part to predict the probability of every pixel belonging to each class, and an estimation part to calculate the bias field, which are optimized alternately. Furthermore, loss functions based on the combination of fuzzy clustering and the multiplicative bias field are also devised. The proposed loss functions introduce the smoothness of bias field and construct the soft relationships among different classes under intra-consistency constraints. Extensive experiments demonstrate that the proposed method can accurately estimate bias fields and produce better bias correction results. The code is available on the link: https://github.com/LeongDong/Bias-Decomposition-Networks.

Efficient automatic segmentation for multi-level pulmonary arteries: The PARSE challenge

Efficient automatic segmentation of multi-level (i.e. main and branch) pulmonary arteries (PA) in CTPA images plays a significant role in clinical applications. However, most existing methods concentrate only on main PA or branch PA segmentation separately and ignore segmentation efficiency. Besides, there is no public large-scale dataset focused on PA segmentation, which makes it highly challenging to compare the different methods. To benchmark multi-level PA segmentation algorithms, we organized the first \textbf{P}ulmonary \textbf{AR}tery \textbf{SE}gmentation (PARSE) challenge. On the one hand, we focus on both the main PA and the branch PA segmentation. On the other hand, for better clinical application, we assign the same score weight to segmentation efficiency (mainly running time and GPU memory consumption during inference) while ensuring PA segmentation accuracy. We present a summary of the top algorithms and offer some suggestions for efficient and accurate multi-level PA automatic segmentation. We provide the PARSE challenge as open-access for the community to benchmark future algorithm developments at \url{https://parse2022.grand-challenge.org/Parse2022/}.

The state-of-the-art 3D anisotropic intracranial hemorrhage segmentation on non-contrast head CT: The INSTANCE challenge

Automatic intracranial hemorrhage segmentation in 3D non-contrast head CT (NCCT) scans is significant in clinical practice. Existing hemorrhage segmentation methods usually ignores the anisotropic nature of the NCCT, and are evaluated on different in-house datasets with distinct metrics, making it highly challenging to improve segmentation performance and perform objective comparisons among different methods. The INSTANCE 2022 was a grand challenge held in conjunction with the 2022 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). It is intended to resolve the above-mentioned problems and promote the development of both intracranial hemorrhage segmentation and anisotropic data processing. The INSTANCE released a training set of 100 cases with ground-truth and a validation set with 30 cases without ground-truth labels that were available to the participants. A held-out testing set with 70 cases is utilized for the final evaluation and ranking. The methods from different participants are ranked based on four metrics, including Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), Relative Volume Difference (RVD) and Normalized Surface Dice (NSD). A total of 13 teams submitted distinct solutions to resolve the challenges, making several baseline models, pre-processing strategies and anisotropic data processing techniques available to future researchers. The winner method achieved an average DSC of 0.6925, demonstrating a significant growth over our proposed baseline method. To the best of our knowledge, the proposed INSTANCE challenge releases the first intracranial hemorrhage segmentation benchmark, and is also the first challenge that intended to resolve the anisotropic problem in 3D medical image segmentation, which provides new alternatives in these research fields.

Position-prior Clustering-based Self-attention Module for Knee Cartilage Segmentation

The morphological changes in knee cartilage (especially femoral and tibial cartilages) are closely related to the progression of knee osteoarthritis, which is expressed by magnetic resonance (MR) images and assessed on the cartilage segmentation results. Thus, it is necessary to propose an effective automatic cartilage segmentation model for longitudinal research on osteoarthritis. In this research, to relieve the problem of inaccurate discontinuous segmentation caused by the limited receptive field in convolutional neural networks, we proposed a novel position-prior clustering-based self-attention module (PCAM). In PCAM, long-range dependency between each class center and feature point is captured by self-attention allowing contextual information re-allocated to strengthen the relative features and ensure the continuity of segmentation result. The clutsering-based method is used to estimate class centers, which fosters intra-class consistency and further improves the accuracy of segmentation results. The position-prior excludes the false positives from side-output and makes center estimation more precise. Sufficient experiments are conducted on OAI-ZIB dataset. The experimental results show that the segmentation performance of combination of segmentation network and PCAM obtains an evident improvement compared to original model, which proves the potential application of PCAM in medical segmentation tasks. The source code is publicly available from link: https://github.com/LeongDong/PCAMNet

ULTRA: Uncertainty-aware Label Distribution Learning for Breast Tumor Cellularity Assessment

Neoadjuvant therapy (NAT) for breast cancer is a common treatment option in clinical practice. Tumor cellularity (TC), which represents the percentage of invasive tumors in the tumor bed, has been widely used to quantify the response of breast cancer to NAT. Therefore, automatic TC estimation is significant in clinical practice. However, existing state-of-the-art methods usually take it as a TC score regression problem, which ignores the ambiguity of TC labels caused by subjective assessment or multiple raters. In this paper, to efficiently leverage the label ambiguities, we proposed an Uncertainty-aware Label disTRibution leArning (ULTRA) framework for automatic TC estimation. The proposed ULTRA first converted the single-value TC labels to discrete label distributions, which effectively models the ambiguity among all possible TC labels. Furthermore, the network learned TC label distributions by minimizing the Kullback-Leibler (KL) divergence between the predicted and ground-truth TC label distributions, which better supervised the model to leverage the ambiguity of TC labels. Moreover, the ULTRA mimicked the multi-rater fusion process in clinical practice with a multi-branch feature fusion module to further explore the uncertainties of TC labels. We evaluated the ULTRA on the public BreastPathQ dataset. The experimental results demonstrate that the ULTRA outperformed the regression-based methods for a large margin and achieved state-of-the-art results. The code will be available from https://github.com/PerceptionComputingLab/ULTRA

Transformer Network for Significant Stenosis Detection in CCTA of Coronary Arteries

Coronary artery disease (CAD) has posed a leading threat to the lives of cardiovascular disease patients worldwide for a long time. Therefore, automated diagnosis of CAD has indispensable significance in clinical medicine. However, the complexity of coronary artery plaques that cause CAD makes the automatic detection of coronary artery stenosis in Coronary CT angiography (CCTA) a difficult task. In this paper, we propose a Transformer network (TR-Net) for the automatic detection of significant stenosis (i.e. luminal narrowing > 50%) while practically completing the computer-assisted diagnosis of CAD. The proposed TR-Net introduces a novel Transformer, and tightly combines convolutional layers and Transformer encoders, allowing their advantages to be demonstrated in the task. By analyzing semantic information sequences, TR-Net can fully understand the relationship between image information in each position of a multiplanar reformatted (MPR) image, and accurately detect significant stenosis based on both local and global information. We evaluate our TR-Net on a dataset of 76 patients from different patients annotated by experienced radiologists. Experimental results illustrate that our TR-Net has achieved better results in ACC (0.92), Spec (0.96), PPV (0.84), F1 (0.79) and MCC (0.74) indicators compared with the state-of-the-art methods. The source code is publicly available from the link (https://github.com/XinghuaMa/TR-Net).

The SARAS Endoscopic Surgeon Action Detection (ESAD) dataset: Challenges and methods

For an autonomous robotic system, monitoring surgeon actions and assisting the main surgeon during a procedure can be very challenging. The challenges come from the peculiar structure of the surgical scene, the greater similarity in appearance of actions performed via tools in a cavity compared to, say, human actions in unconstrained environments, as well as from the motion of the endoscopic camera. This paper presents ESAD, the first large-scale dataset designed to tackle the problem of surgeon action detection in endoscopic minimally invasive surgery. ESAD aims at contributing to increase the effectiveness and reliability of surgical assistant robots by realistically testing their awareness of the actions performed by a surgeon. The dataset provides bounding box annotation for 21 action classes on real endoscopic video frames captured during prostatectomy, and was used as the basis of a recent MIDL 2020 challenge. We also present an analysis of the dataset conducted using the baseline model which was released as part of the challenge, and a description of the top performing models submitted to the challenge together with the results they obtained. This study provides significant insight into what approaches can be effective and can be extended further. We believe that ESAD will serve in the future as a useful benchmark for all researchers active in surgeon action detection and assistive robotics at large.

Weakly Supervised Arrhythmia Detection Based on Deep Convolutional Neural Network

Supervised deep learning has been widely used in the studies of automatic ECG classification, which largely benefits from sufficient annotation of large datasets. However, most of the existing large ECG datasets are roughly annotated, so the classification model trained on them can only detect the existence of abnormalities in a whole recording, but cannot determine their exact occurrence time. In addition, it may take huge time and economic cost to construct a fine-annotated ECG dataset. Therefore, this study proposes weakly supervised deep learning models for detecting abnormal ECG events and their occurrence time. The available supervision information for the models is limited to the event types in an ECG record, excluding the specific occurring time of each event. By leverage of feature locality of deep convolution neural network, the models first make predictions based on the local features, and then aggregate the local predictions to infer the existence of each event during the whole record. Through training, the local predictions are expected to reflect the specific occurring time of each event. To test their potentials, we apply the models for detecting cardiac rhythmic and morphological arrhythmias by using the AFDB and MITDB datasets, respectively. The results show that the models achieve beat-level accuracies of 99.09% in detecting atrial fibrillation, and 99.13% in detecting morphological arrhythmias, which are comparable to that of fully supervised learning models, demonstrating their effectiveness. The local prediction maps revealed by this method are also helpful to analyze and diagnose the decision logic of record-level classification models.

A Global Benchmark of Algorithms for Segmenting Late Gadolinium-Enhanced Cardiac Magnetic Resonance Imaging

Segmentation of cardiac images, particularly late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) widely used for visualizing diseased cardiac structures, is a crucial first step for clinical diagnosis and treatment. However, direct segmentation of LGE-MRIs is challenging due to its attenuated contrast. Since most clinical studies have relied on manual and labor-intensive approaches, automatic methods are of high interest, particularly optimized machine learning approaches. To address this, we organized the "2018 Left Atrium Segmentation Challenge" using 154 3D LGE-MRIs, currently the world's largest cardiac LGE-MRI dataset, and associated labels of the left atrium segmented by three medical experts, ultimately attracting the participation of 27 international teams. In this paper, extensive analysis of the submitted algorithms using technical and biological metrics was performed by undergoing subgroup analysis and conducting hyper-parameter analysis, offering an overall picture of the major design choices of convolutional neural networks (CNNs) and practical considerations for achieving state-of-the-art left atrium segmentation. Results show the top method achieved a dice score of 93.2% and a mean surface to a surface distance of 0.7 mm, significantly outperforming prior state-of-the-art. Particularly, our analysis demonstrated that double, sequentially used CNNs, in which a first CNN is used for automatic region-of-interest localization and a subsequent CNN is used for refined regional segmentation, achieved far superior results than traditional methods and pipelines containing single CNNs. This large-scale benchmarking study makes a significant step towards much-improved segmentation methods for cardiac LGE-MRIs, and will serve as an important benchmark for evaluating and comparing the future works in the field.