The limited availability of 3D medical image datasets, due to privacy concerns and high collection or annotation costs, poses significant challenges in the field of medical imaging. While a promising alternative is the use of synthesized medical data, there are few solutions for realistic 3D medical image synthesis due to difficulties in backbone design and fewer 3D training samples compared to 2D counterparts. In this paper, we propose GEM-3D, a novel generative approach to the synthesis of 3D medical images and the enhancement of existing datasets using conditional diffusion models. Our method begins with a 2D slice, noted as the informed slice to serve the patient prior, and propagates the generation process using a 3D segmentation mask. By decomposing the 3D medical images into masks and patient prior information, GEM-3D offers a flexible yet effective solution for generating versatile 3D images from existing datasets. GEM-3D can enable dataset enhancement by combining informed slice selection and generation at random positions, along with editable mask volumes to introduce large variations in diffusion sampling. Moreover, as the informed slice contains patient-wise information, GEM-3D can also facilitate counterfactual image synthesis and dataset-level de-enhancement with desired control. Experiments on brain MRI and abdomen CT images demonstrate that GEM-3D is capable of synthesizing high-quality 3D medical images with volumetric consistency, offering a straightforward solution for dataset enhancement during inference. The code is available at https://github.com/HKU-MedAI/GEM-3D.
Accurate medical image segmentation demands the integration of multi-scale information, spanning from local features to global dependencies. However, it is challenging for existing methods to model long-range global information, where convolutional neural networks (CNNs) are constrained by their local receptive fields, and vision transformers (ViTs) suffer from high quadratic complexity of their attention mechanism. Recently, Mamba-based models have gained great attention for their impressive ability in long sequence modeling. Several studies have demonstrated that these models can outperform popular vision models in various tasks, offering higher accuracy, lower memory consumption, and less computational burden. However, existing Mamba-based models are mostly trained from scratch and do not explore the power of pretraining, which has been proven to be quite effective for data-efficient medical image analysis. This paper introduces a novel Mamba-based model, Swin-UMamba, designed specifically for medical image segmentation tasks, leveraging the advantages of ImageNet-based pretraining. Our experimental results reveal the vital role of ImageNet-based training in enhancing the performance of Mamba-based models. Swin-UMamba demonstrates superior performance with a large margin compared to CNNs, ViTs, and latest Mamba-based models. Notably, on AbdomenMRI, Encoscopy, and Microscopy datasets, Swin-UMamba outperforms its closest counterpart U-Mamba by an average score of 3.58%. The code and models of Swin-UMamba are publicly available at: https://github.com/JiarunLiu/Swin-UMamba
Recent studies have made remarkable progress in histopathology classification. Based on current successes, contemporary works proposed to further upgrade the model towards a more generalizable and robust direction through incrementally learning from the sequentially delivered domains. Unlike previous parameter isolation based approaches that usually demand massive computation resources during model updating, we present a memory-efficient prompt tuning framework to cultivate model generalization potential in economical memory cost. For each incoming domain, we reuse the existing parameters of the initial classification model and attach lightweight trainable prompts into it for customized tuning. Considering the domain heterogeneity, we perform decoupled prompt tuning, where we adopt a domain-specific prompt for each domain to independently investigate its distinctive characteristics, and one domain-invariant prompt shared across all domains to continually explore the common content embedding throughout time. All domain-specific prompts will be appended to the prompt bank and isolated from further changes to prevent forgetting the distinctive features of early-seen domains. While the domain-invariant prompt will be passed on and iteratively evolve by style-augmented prompt refining to improve model generalization capability over time. In specific, we construct a graph with existing prompts and build a style-augmented graph attention network to guide the domain-invariant prompt exploring the overlapped latent embedding among all delivered domains for more domain generic representations. We have extensively evaluated our framework with two histopathology tasks, i.e., breast cancer metastasis classification and epithelium-stroma tissue classification, where our approach yielded superior performance and memory efficiency over the competing methods.
Surgical 3D reconstruction is a critical area of research in robotic surgery, with recent works adopting variants of dynamic radiance fields to achieve success in 3D reconstruction of deformable tissues from single-viewpoint videos. However, these methods often suffer from time-consuming optimization or inferior quality, limiting their adoption in downstream tasks. Inspired by 3D Gaussian Splatting, a recent trending 3D representation, we present EndoGS, applying Gaussian Splatting for deformable endoscopic tissue reconstruction. Specifically, our approach incorporates deformation fields to handle dynamic scenes, depth-guided supervision to optimize 3D targets with a single viewpoint, and a spatial-temporal weight mask to mitigate tool occlusion. As a result, EndoGS reconstructs and renders high-quality deformable endoscopic tissues from a single-viewpoint video, estimated depth maps, and labeled tool masks. Experiments on DaVinci robotic surgery videos demonstrate that EndoGS achieves superior rendering quality. Code is available at https://github.com/HKU-MedAI/EndoGS.
The utilisation of Plug-and-Play (PnP) priors in inverse problems has become increasingly prominent in recent years. This preference is based on the mathematical equivalence between the general proximal operator and the regularised denoiser, facilitating the adaptation of various off-the-shelf denoiser priors to a wide range of inverse problems. However, existing PnP models predominantly rely on pre-trained denoisers using large datasets. In this work, we introduce Single-Shot PnP methods (SS-PnP), shifting the focus to solving inverse problems with minimal data. First, we integrate Single-Shot proximal denoisers into iterative methods, enabling training with single instances. Second, we propose implicit neural priors based on a novel function that preserves relevant frequencies to capture fine details while avoiding the issue of vanishing gradients. We demonstrate, through extensive numerical and visual experiments, that our method leads to better approximations.
Hospital readmission prediction is considered an essential approach to decreasing readmission rates, which is a key factor in assessing the quality and efficacy of a healthcare system. Previous studies have extensively utilized three primary modalities, namely electronic health records (EHR), medical images, and clinical notes, to predict hospital readmissions. However, the majority of these studies did not integrate information from all three modalities or utilize the spatiotemporal relationships present in the dataset. This study introduces a novel model called the Multimodal Spatiotemporal Graph-Transformer (MuST) for predicting hospital readmissions. By employing Graph Convolution Networks and temporal transformers, we can effectively capture spatial and temporal dependencies in EHR and chest radiographs. We then propose a fusion transformer to combine the spatiotemporal features from the two modalities mentioned above with the features from clinical notes extracted by a pre-trained, domain-specific transformer. We assess the effectiveness of our methods using the latest publicly available dataset, MIMIC-IV. The experimental results indicate that the inclusion of multimodal features in MuST improves its performance in comparison to unimodal methods. Furthermore, our proposed pipeline outperforms the current leading methods in the prediction of hospital readmissions.
Fetal pose estimation in 3D ultrasound (US) involves identifying a set of associated fetal anatomical landmarks. Its primary objective is to provide comprehensive information about the fetus through landmark connections, thus benefiting various critical applications, such as biometric measurements, plane localization, and fetal movement monitoring. However, accurately estimating the 3D fetal pose in US volume has several challenges, including poor image quality, limited GPU memory for tackling high dimensional data, symmetrical or ambiguous anatomical structures, and considerable variations in fetal poses. In this study, we propose a novel 3D fetal pose estimation framework (called FetusMapV2) to overcome the above challenges. Our contribution is three-fold. First, we propose a heuristic scheme that explores the complementary network structure-unconstrained and activation-unreserved GPU memory management approaches, which can enlarge the input image resolution for better results under limited GPU memory. Second, we design a novel Pair Loss to mitigate confusion caused by symmetrical and similar anatomical structures. It separates the hidden classification task from the landmark localization task and thus progressively eases model learning. Last, we propose a shape priors-based self-supervised learning by selecting the relatively stable landmarks to refine the pose online. Extensive experiments and diverse applications on a large-scale fetal US dataset including 1000 volumes with 22 landmarks per volume demonstrate that our method outperforms other strong competitors.
Uncertainty estimation aims to evaluate the confidence of a trained deep neural network. However, existing uncertainty estimation approaches rely on low-dimensional distributional assumptions and thus suffer from the high dimensionality of latent features. Existing approaches tend to focus on uncertainty on discrete classification probabilities, which leads to poor generalizability to uncertainty estimation for other tasks. Moreover, most of the literature requires seeing the out-of-distribution (OOD) data in the training for better estimation of uncertainty, which limits the uncertainty estimation performance in practice because the OOD data are typically unseen. To overcome these limitations, we propose a new framework using data-adaptive high-dimensional hypothesis testing for uncertainty estimation, which leverages the statistical properties of the feature representations. Our method directly operates on latent representations and thus does not require retraining the feature encoder under a modified objective. The test statistic relaxes the feature distribution assumptions to high dimensionality, and it is more discriminative to uncertainties in the latent representations. We demonstrate that encoding features with Bayesian neural networks can enhance testing performance and lead to more accurate uncertainty estimation. We further introduce a family-wise testing procedure to determine the optimal threshold of OOD detection, which minimizes the false discovery rate (FDR). Extensive experiments validate the satisfactory performance of our framework on uncertainty estimation and task-specific prediction over a variety of competitors. The experiments on the OOD detection task also show satisfactory performance of our method when the OOD data are unseen in the training. Codes are available at https://github.com/HKU-MedAI/bnn_uncertainty.
Co-occurrent visual patterns suggest that pixel relation modeling facilitates dense prediction tasks, which inspires the development of numerous context modeling paradigms, \emph{e.g.}, multi-scale-driven and similarity-driven context schemes. Despite the impressive results, these existing paradigms often suffer from inadequate or ineffective contextual information aggregation due to reliance on large amounts of predetermined priors. To alleviate the issues, we propose a novel \textbf{I}ntervention-\textbf{D}riven \textbf{R}elation \textbf{Net}work (\textbf{IDRNet}), which leverages a deletion diagnostics procedure to guide the modeling of contextual relations among different pixels. Specifically, we first group pixel-level representations into semantic-level representations with the guidance of pseudo labels and further improve the distinguishability of the grouped representations with a feature enhancement module. Next, a deletion diagnostics procedure is conducted to model relations of these semantic-level representations via perceiving the network outputs and the extracted relations are utilized to guide the semantic-level representations to interact with each other. Finally, the interacted representations are utilized to augment original pixel-level representations for final predictions. Extensive experiments are conducted to validate the effectiveness of IDRNet quantitatively and qualitatively. Notably, our intervention-driven context scheme brings consistent performance improvements to state-of-the-art segmentation frameworks and achieves competitive results on popular benchmark datasets, including ADE20K, COCO-Stuff, PASCAL-Context, LIP, and Cityscapes. Code is available at \url{https://github.com/SegmentationBLWX/sssegmentation}.
In computation pathology, the pyramid structure of gigapixel Whole Slide Images (WSIs) has recently been studied for capturing various information from individual cell interactions to tissue microenvironments. This hierarchical structure is believed to be beneficial for cancer diagnosis and prognosis tasks. However, most previous hierarchical WSI analysis works (1) only characterize local or global correlations within the WSI pyramids and (2) use only unidirectional interaction between different resolutions, leading to an incomplete picture of WSI pyramids. To this end, this paper presents a novel Hierarchical Interaction Graph-Transformer (i.e., HIGT) for WSI analysis. With Graph Neural Network and Transformer as the building commons, HIGT can learn both short-range local information and long-range global representation of the WSI pyramids. Considering that the information from different resolutions is complementary and can benefit each other during the learning process, we further design a novel Bidirectional Interaction block to establish communication between different levels within the WSI pyramids. Finally, we aggregate both coarse-grained and fine-grained features learned from different levels together for slide-level prediction. We evaluate our methods on two public WSI datasets from TCGA projects, i.e., kidney carcinoma (KICA) and esophageal carcinoma (ESCA). Experimental results show that our HIGT outperforms both hierarchical and non-hierarchical state-of-the-art methods on both tumor subtyping and staging tasks.