2020 CATARACTS Semantic Segmentation Challenge

Surgical scene segmentation is essential for anatomy and instrument localization which can be further used to assess tissue-instrument interactions during a surgical procedure. In 2017, the Challenge on Automatic Tool Annotation for cataRACT Surgery (CATARACTS) released 50 cataract surgery videos accompanied by instrument usage annotations. These annotations included frame-level instrument presence information. In 2020, we released pixel-wise semantic annotations for anatomy and instruments for 4670 images sampled from 25 videos of the CATARACTS training set. The 2020 CATARACTS Semantic Segmentation Challenge, which was a sub-challenge of the 2020 MICCAI Endoscopic Vision (EndoVis) Challenge, presented three sub-tasks to assess participating solutions on anatomical structure and instrument segmentation. Their performance was assessed on a hidden test set of 531 images from 10 videos of the CATARACTS test set.

Artificial Intelligence in Dry Eye Disease

Dry eye disease (DED) has a prevalence of between 5 and 50\%, depending on the diagnostic criteria used and population under study. However, it remains one of the most underdiagnosed and undertreated conditions in ophthalmology. Many tests used in the diagnosis of DED rely on an experienced observer for image interpretation, which may be considered subjective and result in variation in diagnosis. Since artificial intelligence (AI) systems are capable of advanced problem solving, use of such techniques could lead to more objective diagnosis. Although the term `AI' is commonly used, recent success in its applications to medicine is mainly due to advancements in the sub-field of machine learning, which has been used to automatically classify images and predict medical outcomes. Powerful machine learning techniques have been harnessed to understand nuances in patient data and medical images, aiming for consistent diagnosis and stratification of disease severity. This is the first literature review on the use of AI in DED. We provide a brief introduction to AI, report its current use in DED research and its potential for application in the clinic. Our review found that AI has been employed in a wide range of DED clinical tests and research applications, primarily for interpretation of interferometry, slit-lamp and meibography images. While initial results are promising, much work is still needed on model development, clinical testing and standardisation.

Exploring Deep Learning Methods for Real-Time Surgical Instrument Segmentation in Laparoscopy

Minimally invasive surgery is a surgical intervention used to examine the organs inside the abdomen and has been widely used due to its effectiveness over open surgery. Due to the hardware improvements such as high definition cameras, this procedure has significantly improved and new software methods have demonstrated potential for computer-assisted procedures. However, there exists challenges and requirements to improve detection and tracking of the position of the instruments during these surgical procedures. To this end, we evaluate and compare some popular deep learning methods that can be explored for the automated segmentation of surgical instruments in laparoscopy, an important step towards tool tracking. Our experimental results exhibit that the Dual decoder attention network (DDANet) produces a superior result compared to other recent deep learning methods. DDANet yields a Dice coefficient of 0.8739 and mean intersection-over-union of 0.8183 for the Robust Medical Instrument Segmentation (ROBUST-MIS) Challenge 2019 dataset, at a real-time speed of 101.36 frames-per-second that is critical for such procedures.

A Comprehensive Study on Colorectal Polyp Segmentation with ResUNet++, Conditional Random Field and Test-Time Augmentation

Colonoscopy is considered the gold standard for detection of colorectal cancer and its precursors. Existing examination methods are, however, hampered by high overall miss-rate, and many abnormalities are left undetected. Computer-Aided Diagnosis systems based on advanced machine learning algorithms are touted as a game-changer that can identify regions in the colon overlooked by the physicians during endoscopic examinations, and help detect and characterize lesions. In previous work, we have proposed the ResUNet++ architecture and demonstrated that it produces more efficient results compared with its counterparts U-Net and ResUNet. In this paper, we demonstrate that further improvements to the overall prediction performance of the ResUNet++ architecture can be achieved by using conditional random field and test-time augmentation. We have performed extensive evaluations and validated the improvements using six publicly available datasets: Kvasir-SEG, CVC-ClinicDB, CVC-ColonDB, ETIS-Larib Polyp DB, ASU-Mayo Clinic Colonoscopy Video Database, and CVC-VideoClinicDB. Moreover, we compare our proposed architecture and resulting model with other State-of-the-art methods. To explore the generalization capability of ResUNet++ on different publicly available polyp datasets, so that it could be used in a real-world setting, we performed an extensive cross-dataset evaluation. The experimental results show that applying CRF and TTA improves the performance on various polyp segmentation datasets both on the same dataset and cross-dataset.

DivergentNets: Medical Image Segmentation by Network Ensemble

Detection of colon polyps has become a trending topic in the intersecting fields of machine learning and gastrointestinal endoscopy. The focus has mainly been on per-frame classification. More recently, polyp segmentation has gained attention in the medical community. Segmentation has the advantage of being more accurate than per-frame classification or object detection as it can show the affected area in greater detail. For our contribution to the EndoCV 2021 segmentation challenge, we propose two separate approaches. First, a segmentation model named TriUNet composed of three separate UNet models. Second, we combine TriUNet with an ensemble of well-known segmentation models, namely UNet++, FPN, DeepLabv3, and DeepLabv3+, into a model called DivergentNets to produce more generalizable medical image segmentation masks. In addition, we propose a modified Dice loss that calculates loss only for a single class when performing multiclass segmentation, forcing the model to focus on what is most important. Overall, the proposed methods achieved the best average scores for each respective round in the challenge, with TriUNet being the winning model in Round I and DivergentNets being the winning model in Round II of the segmentation generalization challenge at EndoCV 2021. The implementation of our approach is made publicly available on GitHub.

SinGAN-Seg: Synthetic Training Data Generation for Medical Image Segmentation

Processing medical data to find abnormalities is a time-consuming and costly task, requiring tremendous efforts from medical experts. Therefore, Ai has become a popular tool for the automatic processing of medical data, acting as a supportive tool for doctors. AI tools highly depend on data for training the models. However, there are several constraints to access to large amounts of medical data to train machine learning algorithms in the medical domain, e.g., due to privacy concerns and the costly, time-consuming medical data annotation process. To address this, in this paper we present a novel synthetic data generation pipeline called SinGAN-Seg to produce synthetic medical data with the corresponding annotated ground truth masks. We show that these synthetic data generation pipelines can be used as an alternative to bypass privacy concerns and as an alternative way to produce artificial segmentation datasets with corresponding ground truth masks to avoid the tedious medical data annotation process. As a proof of concept, we used an open polyp segmentation dataset. By training UNet++ using both the real polyp segmentation dataset and the corresponding synthetic dataset generated from the SinGAN-Seg pipeline, we show that the synthetic data can achieve a very close performance to the real data when the real segmentation datasets are large enough. In addition, we show that synthetic data generated from the SinGAN-Seg pipeline improving the performance of segmentation algorithms when the training dataset is very small. Since our SinGAN-Seg pipeline is applicable for any medical dataset, this pipeline can be used with any other segmentation datasets.

PolypGen: A multi-center polyp detection and segmentation dataset for generalisability assessment

Polyps in the colon are widely known as cancer precursors identified by colonoscopy either related to diagnostic work-up for symptoms, colorectal cancer screening or systematic surveillance of certain diseases. Whilst most polyps are benign, the number, size and the surface structure of the polyp are tightly linked to the risk of colon cancer. There exists a high missed detection rate and incomplete removal of colon polyps due to the variable nature, difficulties to delineate the abnormality, high recurrence rates and the anatomical topography of the colon. In the past, several methods have been built to automate polyp detection and segmentation. However, the key issue of most methods is that they have not been tested rigorously on a large multi-center purpose-built dataset. Thus, these methods may not generalise to different population datasets as they overfit to a specific population and endoscopic surveillance. To this extent, we have curated a dataset from 6 different centers incorporating more than 300 patients. The dataset includes both single frame and sequence data with 3446 annotated polyp labels with precise delineation of polyp boundaries verified by six senior gastroenterologists. To our knowledge, this is the most comprehensive detection and pixel-level segmentation dataset curated by a team of computational scientists and expert gastroenterologists. This dataset has been originated as the part of the Endocv2021 challenge aimed at addressing generalisability in polyp detection and segmentation. In this paper, we provide comprehensive insight into data construction and annotation strategies, annotation quality assurance and technical validation for our extended EndoCV2021 dataset which we refer to as PolypGen.

Few-shot segmentation of medical images based on meta-learning with implicit gradients

Classical supervised methods commonly used often suffer from the requirement of an abudant number of training samples and are unable to generalize on unseen datasets. As a result, the broader application of any trained model is very limited in clinical settings. However, few-shot approaches can minimize the need for enormous reliable ground truth labels that are both labor intensive and expensive. To this end, we propose to exploit an optimization-based implicit model agnostic meta-learning {iMAML} algorithm in a few-shot setting for medical image segmentation. Our approach can leverage the learned weights from a diverse set of training samples and can be deployed on a new unseen dataset. We show that unlike classical few-shot learning approaches, our method has improved generalization capability. To our knowledge, this is the first work that exploits iMAML for medical image segmentation. Our quantitative results on publicly available skin and polyp datasets show that the proposed method outperforms the naive supervised baseline model and two recent few-shot segmentation approaches by large margins.

MSRF-Net: A Multi-Scale Residual Fusion Network for Biomedical Image Segmentation

Methods based on convolutional neural networks have improved the performance of biomedical image segmentation. However, most of these methods cannot efficiently segment objects of variable sizes and train on small and biased datasets, which are common in biomedical use cases. While methods exist that incorporate multi-scale fusion approaches to address the challenges arising with variable sizes, they usually use complex models that are more suitable for general semantic segmentation computer vision problems. In this paper, we propose a novel architecture called MSRF-Net, which is specially designed for medical image segmentation tasks. The proposed MSRF-Net is able to exchange multi-scale features of varying receptive fields using a dual-scale dense fusion block (DSDF). Our DSDF block can exchange information rigorously across two different resolution scales, and our MSRF sub-network uses multiple DSDF blocks in sequence to perform multi-scale fusion. This allows the preservation of resolution, improved information flow, and propagation of both high- and low-level features to obtain accurate segmentation maps. The proposed MSRF-Net allows to capture object variabilities and provides improved results on different biomedical datasets. Extensive experiments on MSRF-Net demonstrate that the proposed method outperforms most of the cutting-edge medical image segmentation state-of-the-art methods. MSRF-Net advances the performance on four publicly available datasets, and also, MSRF-Net is more generalizable as compared to state-of-the-art methods.

NanoNet: Real-Time Polyp Segmentation in Video Capsule Endoscopy and Colonoscopy

Deep learning in gastrointestinal endoscopy can assist to improve clinical performance and be helpful to assess lesions more accurately. To this extent, semantic segmentation methods that can perform automated real-time delineation of a region-of-interest, e.g., boundary identification of cancer or precancerous lesions, can benefit both diagnosis and interventions. However, accurate and real-time segmentation of endoscopic images is extremely challenging due to its high operator dependence and high-definition image quality. To utilize automated methods in clinical settings, it is crucial to design lightweight models with low latency such that they can be integrated with low-end endoscope hardware devices. In this work, we propose NanoNet, a novel architecture for the segmentation of video capsule endoscopy and colonoscopy images. Our proposed architecture allows real-time performance and has higher segmentation accuracy compared to other more complex ones. We use video capsule endoscopy and standard colonoscopy datasets with polyps, and a dataset consisting of endoscopy biopsies and surgical instruments, to evaluate the effectiveness of our approach. Our experiments demonstrate the increased performance of our architecture in terms of a trade-off between model complexity, speed, model parameters, and metric performances. Moreover, the resulting model size is relatively tiny, with only nearly 36,000 parameters compared to traditional deep learning approaches having millions of parameters.