Redesigning Out-of-Distribution Detection on 3D Medical Images

Detecting out-of-distribution (OOD) samples for trusted medical image segmentation remains a significant challenge. The critical issue here is the lack of a strict definition of abnormal data, which often results in artificial problem settings without measurable clinical impact. In this paper, we redesign the OOD detection problem according to the specifics of volumetric medical imaging and related downstream tasks (e.g., segmentation). We propose using the downstream model's performance as a pseudometric between images to define abnormal samples. This approach enables us to weigh different samples based on their performance impact without an explicit ID/OOD distinction. We incorporate this weighting in a new metric called Expected Performance Drop (EPD). EPD is our core contribution to the new problem design, allowing us to rank methods based on their clinical impact. We demonstrate the effectiveness of EPD-based evaluation in 11 CT and MRI OOD detection challenges.

vox2vec: A Framework for Self-supervised Contrastive Learning of Voxel-level Representations in Medical Images

This paper introduces vox2vec - a contrastive method for self-supervised learning (SSL) of voxel-level representations. vox2vec representations are modeled by a Feature Pyramid Network (FPN): a voxel representation is a concatenation of the corresponding feature vectors from different pyramid levels. The FPN is pre-trained to produce similar representations for the same voxel in different augmented contexts and distinctive representations for different voxels. This results in unified multi-scale representations that capture both global semantics (e.g., body part) and local semantics (e.g., different small organs or healthy versus tumor tissue). We use vox2vec to pre-train a FPN on more than 6500 publicly available computed tomography images. We evaluate the pre-trained representations by attaching simple heads on top of them and training the resulting models for 22 segmentation tasks. We show that vox2vec outperforms existing medical imaging SSL techniques in three evaluation setups: linear and non-linear probing and end-to-end fine-tuning. Moreover, a non-linear head trained on top of the frozen vox2vec representations achieves competitive performance with the FPN trained from scratch while having 50 times fewer trainable parameters. The code is available at https://github.com/mishgon/vox2vec .

Limitations of Out-of-Distribution Detection in 3D Medical Image Segmentation

Deep Learning models perform unreliably when the data comes from a distribution different from the training one. In critical applications such as medical imaging, out-of-distribution (OOD) detection methods help to identify such data samples, preventing erroneous predictions. In this paper, we further investigate the OOD detection effectiveness when applied to 3D medical image segmentation. We design several OOD challenges representing clinically occurring cases and show that none of these methods achieve acceptable performance. Methods not dedicated to segmentation severely fail to perform in the designed setups; their best mean false positive rate at 95% true positive rate (FPR) is 0.59. Segmentation-dedicated ones still achieve suboptimal performance, with the best mean FPR of 0.31 (lower is better). To indicate this suboptimality, we develop a simple method called Intensity Histogram Features (IHF), which performs comparable or better in the same challenges, with a mean FPR of 0.25. Our findings highlight the limitations of the existing OOD detection methods on 3D medical images and present a promising avenue for improving them. To facilitate research in this area, we release the designed challenges as a publicly available benchmark and formulate practical criteria to test the OOD detection generalization beyond the suggested benchmark. We also propose IHF as a solid baseline to contest the emerging methods.

Solving Sample-Level Out-of-Distribution Detection on 3D Medical Images

Deep Learning (DL) models tend to perform poorly when the data comes from a distribution different from the training one. In critical applications such as medical imaging, out-of-distribution (OOD) detection helps to identify such data samples, increasing the model's reliability. Recent works have developed DL-based OOD detection that achieves promising results on 2D medical images. However, scaling most of these approaches on 3D images is computationally intractable. Furthermore, the current 3D solutions struggle to achieve acceptable results in detecting even synthetic OOD samples. Such limited performance might indicate that DL often inefficiently embeds large volumetric images. We argue that using the intensity histogram of the original CT or MRI scan as embedding is descriptive enough to run OOD detection. Therefore, we propose a histogram-based method that requires no DL and achieves almost perfect results in this domain. Our proposal is supported two-fold. We evaluate the performance on the publicly available datasets, where our method scores 1.0 AUROC in most setups. And we score second in the Medical Out-of-Distribution challenge without fine-tuning and exploiting task-specific knowledge. Carefully discussing the limitations, we conclude that our method solves the sample-level OOD detection on 3D medical images in the current setting.

Exploring Structure-Wise Uncertainty for 3D Medical Image Segmentation

When applying a Deep Learning model to medical images, it is crucial to estimate the model uncertainty. Voxel-wise uncertainty is a useful visual marker for human experts and could be used to improve the model's voxel-wise output, such as segmentation. Moreover, uncertainty provides a solid foundation for out-of-distribution (OOD) detection, improving the model performance on the image-wise level. However, one of the frequent tasks in medical imaging is the segmentation of distinct, local structures such as tumors or lesions. Here, the structure-wise uncertainty allows more precise operations than image-wise and more semantic-aware than voxel-wise. The way to produce uncertainty for individual structures remains poorly explored. We propose a framework to measure the structure-wise uncertainty and evaluate the impact of OOD data on the model performance. Thus, we identify the best UE method to improve the segmentation quality. The proposed framework is tested on three datasets with the tumor segmentation task: LIDC-IDRI, LiTS, and a private one with multiple brain metastases cases.

Interpretable Vertebral Fracture Quantification via Anchor-Free Landmarks Localization

Vertebral body compression fractures are early signs of osteoporosis. Though these fractures are visible on Computed Tomography (CT) images, they are frequently missed by radiologists in clinical settings. Prior research on automatic methods of vertebral fracture classification proves its reliable quality; however, existing methods provide hard-to-interpret outputs and sometimes fail to process cases with severe abnormalities such as highly pathological vertebrae or scoliosis. We propose a new two-step algorithm to localize the vertebral column in 3D CT images and then detect individual vertebrae and quantify fractures in 2D simultaneously. We train neural networks for both steps using a simple 6-keypoints based annotation scheme, which corresponds precisely to the current clinical recommendation. Our algorithm has no exclusion criteria, processes 3D CT in 2 seconds on a single GPU, and provides an interpretable and verifiable output. The method approaches expert-level performance and demonstrates state-of-the-art results in vertebrae 3D localization (the average error is 1 mm), vertebrae 2D detection (precision and recall are 0.99), and fracture identification (ROC AUC at the patient level is up to 0.96). Our anchor-free vertebra detection network shows excellent generalizability on a new domain by achieving ROC AUC 0.95, sensitivity 0.85, specificity 0.9 on a challenging VerSe dataset with many unseen vertebra types.

Neglectable effect of brain MRI data prepreprocessing for tumor segmentation

Magnetic resonance imaging (MRI) data is heterogeneous due to the differences in device manufacturers, scanning protocols, and inter-subject variability. A conventional way to mitigate MR image heterogeneity is to apply preprocessing transformations, such as anatomy alignment, voxel resampling, signal intensity equalization, image denoising, and localization of regions of interest (ROI). Although preprocessing pipeline standardizes image appearance, its influence on the quality of image segmentation and other downstream tasks on deep neural networks (DNN) has never been rigorously studied. Here we report a comprehensive study of multimodal MRI brain cancer image segmentation on TCIA-GBM open-source dataset. Our results demonstrate that most popular standardization steps add no value to artificial neural network performance; moreover, preprocessing can hamper model performance. We suggest that image intensity normalization approaches do not contribute to model accuracy because of the reduction of signal variance with image standardization. Finally, we show the contribution of scull-stripping in data preprocessing is almost negligible if measured in terms of clinically relevant metrics. We show that the only essential transformation for accurate analysis is the unification of voxel spacing across the dataset. In contrast, anatomy alignment in form of non-rigid atlas registration is not necessary and most intensity equalization steps do not improve model productiveness.

Adaptation to CT Reconstruction Kernels by Enforcing Cross-domain Feature Maps Consistency

Deep learning methods provide significant assistance in analyzing coronavirus disease (COVID-19) in chest computed tomography (CT) images, including identification, severity assessment, and segmentation. Although the earlier developed methods address the lack of data and specific annotations, the current goal is to build a robust algorithm for clinical use, having a larger pool of available data. With the larger datasets, the domain shift problem arises, affecting the performance of methods on the unseen data. One of the critical sources of domain shift in CT images is the difference in reconstruction kernels used to generate images from the raw data (sinograms). In this paper, we show a decrease in the COVID-19 segmentation quality of the model trained on the smooth and tested on the sharp reconstruction kernels. Furthermore, we compare several domain adaptation approaches to tackle the problem, such as task-specific augmentation and unsupervised adversarial learning. Finally, we propose the unsupervised adaptation method, called F-Consistency, that outperforms the previous approaches. Our method exploits a set of unlabeled CT image pairs which differ only in reconstruction kernels within every pair. It enforces the similarity of the network hidden representations (feature maps) by minimizing mean squared error (MSE) between paired feature maps. We show our method achieving 0.64 Dice Score on the test dataset with unseen sharp kernels, compared to the 0.56 Dice Score of the baseline model. Moreover, F-Consistency scores 0.80 Dice Score between predictions on the paired images, which almost doubles the baseline score of 0.46 and surpasses the other methods. We also show F-Consistency to better generalize on the unseen kernels and without the specific semantic content, e.g., presence of the COVID-19 lesions.

Systematic Clinical Evaluation of A Deep Learning Method for Medical Image Segmentation: Radiosurgery Application

We systematically evaluate a Deep Learning (DL) method in a 3D medical image segmentation task. Our segmentation method is integrated into the radiosurgery treatment process and directly impacts the clinical workflow. With our method, we address the relative drawbacks of manual segmentation: high inter-rater contouring variability and high time consumption of the contouring process. The main extension over the existing evaluations is the careful and detailed analysis that could be further generalized on other medical image segmentation tasks. Firstly, we analyze the changes in the inter-rater detection agreement. We show that the segmentation model reduces the ratio of detection disagreements from 0.162 to 0.085 (p < 0.05). Secondly, we show that the model improves the inter-rater contouring agreement from 0.845 to 0.871 surface Dice Score (p < 0.05). Thirdly, we show that the model accelerates the delineation process in between 1.6 and 2.0 times (p < 0.05). Finally, we design the setup of the clinical experiment to either exclude or estimate the evaluation biases, thus preserve the significance of the results. Besides the clinical evaluation, we also summarize the intuitions and practical ideas for building an efficient DL-based model for 3D medical image segmentation.

Zero-Shot Domain Adaptation in CT Segmentation by Filtered Back Projection Augmentation

Domain shift is one of the most salient challenges in medical computer vision. Due to immense variability in scanners' parameters and imaging protocols, even images obtained from the same person and the same scanner could differ significantly. We address variability in computed tomography (CT) images caused by different convolution kernels used in the reconstruction process, the critical domain shift factor in CT. The choice of a convolution kernel affects pixels' granularity, image smoothness, and noise level. We analyze a dataset of paired CT images, where smooth and sharp images were reconstructed from the same sinograms with different kernels, thus providing identical anatomy but different style. Though identical predictions are desired, we show that the consistency, measured as the average Dice between predictions on pairs, is just 0.54. We propose Filtered Back-Projection Augmentation (FBPAug), a simple and surprisingly efficient approach to augment CT images in sinogram space emulating reconstruction with different kernels. We apply the proposed method in a zero-shot domain adaptation setup and show that the consistency boosts from 0.54 to 0.92 outperforming other augmentation approaches. Neither specific preparation of source domain data nor target domain data is required, so our publicly released FBPAug can be used as a plug-and-play module for zero-shot domain adaptation in any CT-based task.