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.

Anatomy of Domain Shift Impact on U-Net Layers in MRI Segmentation

Domain Adaptation (DA) methods are widely used in medical image segmentation tasks to tackle the problem of differently distributed train (source) and test (target) data. We consider the supervised DA task with a limited number of annotated samples from the target domain. It corresponds to one of the most relevant clinical setups: building a sufficiently accurate model on the minimum possible amount of annotated data. Existing methods mostly fine-tune specific layers of the pretrained Convolutional Neural Network (CNN). However, there is no consensus on which layers are better to fine-tune, e.g. the first layers for images with low-level domain shift or the deeper layers for images with high-level domain shift. To this end, we propose SpotTUnet - a CNN architecture that automatically chooses the layers which should be optimally fine-tuned. More specifically, on the target domain, our method additionally learns the policy that indicates whether a specific layer should be fine-tuned or reused from the pretrained network. We show that our method performs at the same level as the best of the nonflexible fine-tuning methods even under the extreme scarcity of annotated data. Secondly, we show that SpotTUnet policy provides a layer-wise visualization of the domain shift impact on the network, which could be further used to develop robust domain generalization methods. In order to extensively evaluate SpotTUnet performance, we use a publicly available dataset of brain MR images (CC359), characterized by explicit domain shift. We release a reproducible experimental pipeline.

First U-Net Layers Contain More Domain Specific Information Than The Last Ones

MRI scans appearance significantly depends on scanning protocols and, consequently, the data-collection institution. These variations between clinical sites result in dramatic drops of CNN segmentation quality on unseen domains. Many of the recently proposed MRI domain adaptation methods operate with the last CNN layers to suppress domain shift. At the same time, the core manifestation of MRI variability is a considerable diversity of image intensities. We hypothesize that these differences can be eliminated by modifying the first layers rather than the last ones. To validate this simple idea, we conducted a set of experiments with brain MRI scans from six domains. Our results demonstrate that 1) domain-shift may deteriorate the quality even for a simple brain extraction segmentation task (surface Dice Score drops from 0.85-0.89 even to 0.09); 2) fine-tuning of the first layers significantly outperforms fine-tuning of the last layers in almost all supervised domain adaptation setups. Moreover, fine-tuning of the first layers is a better strategy than fine-tuning of the whole network, if the amount of annotated data from the new domain is strictly limited.

Universal Loss Reweighting to Balance Lesion Size Inequality in 3D Medical Image Segmentation

Target imbalance affects the performance of recent deep learning methods in many medical image segmentation tasks. It is a twofold problem: class imbalance - positive class (lesion) size compared to negative class (non-lesion) size; lesion size imbalance - large lesions overshadows small ones (in the case of multiple lesions per image). While the former was addressed in multiple works, the latter lacks investigation. We propose a loss reweighting approach to increase the ability of the network to detect small lesions. During the learning process, we assign a weight to every image voxel. The assigned weights are inversely proportional to the lesion volume, thus smaller lesions get larger weights. We report the benefit from our method for well-known loss functions, including Dice Loss, Focal Loss, and Asymmetric Similarity Loss. Additionally, we compare our results with other reweighting techniques: Weighted Cross-Entropy and Generalized Dice Loss. Our experiments show that inverse weighting considerably increases the detection quality, while preserves the delineation quality on a state-of-the-art level. We publish a complete experimental pipeline for two publicly available datasets of CT images: LiTS and LUNA16 (https://github.com/neuro-ml/inverse_weighting). We also show results on a private database of MR images for the task of multiple brain metastases delineation.

CT-based COVID-19 Triage: Deep Multitask Learning Improves Joint Identification and Severity Quantification

The current COVID-19 pandemic overloads healthcare systems, including radiology departments. Though several deep learning approaches were developed to assist in CT analysis, nobody considered study triage directly as a computer science problem. We describe two basic setups: Identification of COVID-19 to prioritize studies of potentially infected patients to isolate them as early as possible; Severity quantification to highlight studies of severe patients and direct them to a hospital or provide emergency medical care. We formalize these tasks as binary classification and estimation of affected lung percentage. Though similar problems were well-studied separately, we show that existing methods provide reasonable quality only for one of these setups. To consolidate both triage approaches, we employ a multitask learning and propose a convolutional neural network to combine all available labels within a single model. We train our model on approximately 2000 publicly available CT studies and test it with a carefully designed set consisting of 33 COVID patients, 32 healthy patients, and 36 patients with other lung pathologies to emulate a typical patient flow in an out-patient hospital. The developed model achieved 0.951 ROC AUC for Identification of COVID-19 and 0.98 Spearman Correlation for Severity quantification. We release all the code and create a public leaderboard, where other community members can test their models on our dataset.

Keypoints Localization for Joint Vertebra Detection and Fracture Severity Quantification

Vertebral body compression fractures are reliable 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 to simultaneously detect individual vertebrae and quantify fractures in 2D. We train neural networks for both steps using a simple 6-keypoints based annotation scheme, which corresponds precisely to current medical recommendation. Our algorithm has no exclusion criteria, processes 3D CT in 2 seconds on a single GPU, and provides an intuitive 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 is 0.99, recall is 1), and fracture identification (ROC AUC at the patient level is 0.93).

Multi-domain CT metal artifacts reduction using partial convolution based inpainting

Recent CT Metal Artifacts Reduction (MAR) methods are often based on image-to-image convolutional neural networks for adjustment of corrupted sinograms or images themselves. In this paper, we are exploring the capabilities of a multi-domain method which consists of both sinogram correction (projection domain step) and restored image correction (image-domain step). Moreover, we propose a formulation of the first step problem as sinogram inpainting which allows us to use methods of this specific field such as partial convolutions. The proposed method allows to achieve state-of-the-art (-75% MSE) improvement in comparison with a classic benchmark - Li-MAR.

Deep Learning for Brain Tumor Segmentation in Radiosurgery: Prospective Clinical Evaluation

Stereotactic radiosurgery is a minimally-invasive treatment option for a large number of patients with intracranial tumors. As part of the therapy treatment, accurate delineation of brain tumors is of great importance. However, slice-by-slice manual segmentation on T1c MRI could be time-consuming (especially for multiple metastases) and subjective (especially for meningiomas). In our work, we compared several deep convolutional networks architectures and training procedures and evaluated the best model in a radiation therapy department for three types of brain tumors: meningiomas, schwannomas and multiple brain metastases. The developed semiautomatic segmentation system accelerates the contouring process by 2.2 times on average and increases inter-rater agreement from 92% to 96.5%.

Incorporating Task-Specific Structural Knowledge into CNNs for Brain Midline Shift Detection

Midline shift (MLS) is a well-established factor used for outcome prediction in traumatic brain injury, stroke and brain tumors. The importance of automatic estimation of MLS was recently highlighted by ACR Data Science Institute. In this paper we introduce a novel deep learning based approach for the problem of MLS detection, which exploits task-specific structural knowledge. We evaluate our method on a large dataset containing heterogeneous images with significant MLS and show that its mean error approaches the inter-expert variability. Finally, we show the robustness of our approach by validating it on an external dataset, acquired during routine clinical practice.

Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. Automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their method on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge (https://wmh.isi.uu.nl/). Sixty T1+FLAIR images from three MR scanners were released with manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. Segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: (1) Dice similarity coefficient, (2) modified Hausdorff distance (95th percentile), (3) absolute log-transformed volume difference, (4) sensitivity for detecting individual lesions, and (5) F1-score for individual lesions. Additionally, methods were ranked on their inter-scanner robustness. Twenty participants submitted their method for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation.