Surf-CDM: Score-Based Surface Cold-Diffusion Model For Medical Image Segmentation

Diffusion models have shown impressive performance for image generation, often times outperforming other generative models. Since their introduction, researchers have extended the powerful noise-to-image denoising pipeline to discriminative tasks, including image segmentation. In this work we propose a conditional score-based generative modeling framework for medical image segmentation which relies on a parametric surface representation for the segmentation masks. The surface re-parameterization allows the direct application of standard diffusion theory, as opposed to when the mask is represented as a binary mask. Moreover, we adapted an extended variant of the diffusion technique known as the "cold-diffusion" where the diffusion model can be constructed with deterministic perturbations instead of Gaussian noise, which facilitates significantly faster convergence in the reverse diffusion. We evaluated our method on the segmentation of the left ventricle from 65 transthoracic echocardiogram videos (2230 echo image frames) and compared its performance to the most popular and widely used image segmentation models. Our proposed model not only outperformed the compared methods in terms of segmentation accuracy, but also showed potential in estimating segmentation uncertainties for further downstream analyses due to its inherent generative nature.

U-Net v2: Rethinking the Skip Connections of U-Net for Medical Image Segmentation

In this paper, we introduce U-Net v2, a new robust and efficient U-Net variant for medical image segmentation. It aims to augment the infusion of semantic information into low-level features while simultaneously refining high-level features with finer details. For an input image, we begin by extracting multi-level features with a deep neural network encoder. Next, we enhance the feature map of each level by infusing semantic information from higher-level features and integrating finer details from lower-level features through Hadamard product. Our novel skip connections empower features of all the levels with enriched semantic characteristics and intricate details. The improved features are subsequently transmitted to the decoder for further processing and segmentation. Our method can be seamlessly integrated into any Encoder-Decoder network. We evaluate our method on several public medical image segmentation datasets for skin lesion segmentation and polyp segmentation, and the experimental results demonstrate the segmentation accuracy of our new method over state-of-the-art methods, while preserving memory and computational efficiency. Code is available at: https://github.com/yaoppeng/U-Net\_v2

PHG-Net: Persistent Homology Guided Medical Image Classification

Modern deep neural networks have achieved great successes in medical image analysis. However, the features captured by convolutional neural networks (CNNs) or Transformers tend to be optimized for pixel intensities and neglect key anatomical structures such as connected components and loops. In this paper, we propose a persistent homology guided approach (PHG-Net) that explores topological features of objects for medical image classification. For an input image, we first compute its cubical persistence diagram and extract topological features into a vector representation using a small neural network (called the PH module). The extracted topological features are then incorporated into the feature map generated by CNN or Transformer for feature fusion. The PH module is lightweight and capable of integrating topological features into any CNN or Transformer architectures in an end-to-end fashion. We evaluate our PHG-Net on three public datasets and demonstrate its considerable improvements on the target classification tasks over state-of-the-art methods.

Trust, but Verify: Robust Image Segmentation using Deep Learning

We describe a method for verifying the output of a deep neural network for medical image segmentation that is robust to several classes of random as well as worst-case perturbations i.e. adversarial attacks. This method is based on a general approach recently developed by the authors called "Trust, but Verify" wherein an auxiliary verification network produces predictions about certain masked features in the input image using the segmentation as an input. A well-designed auxiliary network will produce high-quality predictions when the input segmentations are accurate, but will produce low-quality predictions when the segmentations are incorrect. Checking the predictions of such a network with the original image allows us to detect bad segmentations. However, to ensure the verification method is truly robust, we need a method for checking the quality of the predictions that does not itself rely on a black-box neural network. Indeed, we show that previous methods for segmentation evaluation that do use deep neural regression networks are vulnerable to false negatives i.e. can inaccurately label bad segmentations as good. We describe the design of a verification network that avoids such vulnerability and present results to demonstrate its robustness compared to previous methods.

Provable Multi-instance Deep AUC Maximization with Stochastic Pooling

This paper considers a novel application of deep AUC maximization (DAM) for multi-instance learning (MIL), in which a single class label is assigned to a bag of instances (e.g., multiple 2D slices of a CT scan for a patient). We address a neglected yet non-negligible computational challenge of MIL in the context of DAM, i.e., bag size is too large to be loaded into {GPU} memory for backpropagation, which is required by the standard pooling methods of MIL. To tackle this challenge, we propose variance-reduced stochastic pooling methods in the spirit of stochastic optimization by formulating the loss function over the pooled prediction as a multi-level compositional function. By synthesizing techniques from stochastic compositional optimization and non-convex min-max optimization, we propose a unified and provable muli-instance DAM (MIDAM) algorithm with stochastic smoothed-max pooling or stochastic attention-based pooling, which only samples a few instances for each bag to compute a stochastic gradient estimator and to update the model parameter. We establish a similar convergence rate of the proposed MIDAM algorithm as the state-of-the-art DAM algorithms. Our extensive experiments on conventional MIL datasets and medical datasets demonstrate the superiority of our MIDAM algorithm.

Automated segmentation of choroidal layers from 3-dimensional macular optical coherence tomography scans

Background: Changes in choroidal thickness are associated with various ocular diseases and the choroid can be imaged using spectral-domain optical coherence tomography (SDOCT) and enhanced depth imaging OCT (EDIOCT). New Method: Eighty macular SDOCT volumes from 80 patients were obtained using the Zeiss Cirrus machine. Eleven additional control subjects had two Cirrus scans done in one visit along with EDIOCT using the Heidelberg Spectralis machine. To automatically segment choroidal layers from the OCT volumes, our graph-theoretic approach was utilized. The segmentation results were compared with reference standards from two graders, and the accuracy of automated segmentation was calculated using unsigned to signed border positioning thickness errors and Dice similarity coefficient (DSC). The repeatability and reproducibility of our choroidal thicknesses were determined by intraclass correlation coefficient (ICC), coefficient of variation (CV), and repeatability coefficient (RC). Results: The mean unsigned to signed border positioning errors for the choroidal inner and outer surfaces are 3.39plusminus1.26microns (mean plusminus SD) to minus1.52 plusminus 1.63microns and 16.09 plusminus 6.21microns to 4.73 plusminus 9.53microns, respectively. The mean unsigned to signed choroidal thickness errors are 16.54 plusminus 6.47microns to 6.25 plusminus 9.91microns, and the mean DSC is 0.949 plusminus 0.025. The ICC (95% CI), CV, RC values are 0.991 (0.977 to 0.997), 2.48%, 3.15microns for the repeatability and 0.991 (0.977 to 0.997), 2.49%, 0.53microns for the reproducibility studies, respectively. Comparison with Existing Method(s): The proposed method outperformed our previous method using choroidal vessel segmentation and inter-grader variability. Conclusions: This automated segmentation method can reliably measure choroidal thickness using different OCT platforms.

Robust Deep AUC Maximization: A New Surrogate Loss and Empirical Studies on Medical Image Classification

Deep AUC Maximization (DAM) is a paradigm for learning a deep neural network by maximizing the AUC score of the model on a dataset. Most previous works of AUC maximization focus on the perspective of optimization by designing efficient stochastic algorithms, and studies on generalization performance of DAM on difficult tasks are missing. In this work, we aim to make DAM more practical for interesting real-world applications (e.g., medical image classification). First, we propose a new margin-based surrogate loss function for the AUC score (named as the AUC margin loss). It is more robust than the commonly used AUC square loss, while enjoying the same advantage in terms of large-scale stochastic optimization. Second, we conduct empirical studies of our DAM method on difficult medical image classification tasks, namely classification of chest x-ray images for identifying many threatening diseases and classification of images of skin lesions for identifying melanoma. Our DAM method has achieved great success on these difficult tasks, i.e., the 1st place on Stanford CheXpert competition (by the paper submission date) and Top 1% rank (rank 33 out of 3314 teams) on Kaggle 2020 Melanoma classification competition. We also conduct extensive ablation studies to demonstrate the advantages of the new AUC margin loss over the AUC square loss on benchmark datasets. To the best of our knowledge, this is the first work that makes DAM succeed on large-scale medical image datasets.

COVID CT-Net: Predicting Covid-19 From Chest CT Images Using Attentional Convolutional Network

The novel corona-virus disease (COVID-19) pandemic has caused a major outbreak in more than 200 countries around the world, leading to a severe impact on the health and life of many people globally. As of Aug 25th of 2020, more than 20 million people are infected, and more than 800,000 death are reported. Computed Tomography (CT) images can be used as a as an alternative to the time-consuming "reverse transcription polymerase chain reaction (RT-PCR)" test, to detect COVID-19. In this work we developed a deep learning framework to predict COVID-19 from CT images. We propose to use an attentional convolution network, which can focus on the infected areas of chest, enabling it to perform a more accurate prediction. We trained our model on a dataset of more than 2000 CT images, and report its performance in terms of various popular metrics, such as sensitivity, specificity, area under the curve, and also precision-recall curve, and achieve very promising results. We also provide a visualization of the attention maps of the model for several test images, and show that our model is attending to the infected regions as intended. In addition to developing a machine learning modeling framework, we also provide the manual annotation of the potentionally infected regions of chest, with the help of a board-certified radiologist, and make that publicly available for other researchers.

COVID TV-UNet: Segmenting COVID-19 Chest CT Images Using Connectivity Imposed U-Net

The novel corona-virus disease (COVID-19) pandemic has caused a major outbreak in more than 200 countries around the world, leading to a severe impact on the health and life of many people globally. As of mid-July 2020, more than 12 million people were infected, and more than 570,000 death were reported. Computed Tomography (CT) images can be used as an alternative to the time-consuming RT-PCR test, to detect COVID-19. In this work we propose a segmentation framework to detect chest regions in CT images, which are infected by COVID-19. We use an architecture similar to U-Net model, and train it to detect ground glass regions, on pixel level. As the infected regions tend to form a connected component (rather than randomly distributed pixels), we add a suitable regularization term to the loss function, to promote connectivity of the segmentation map for COVID-19 pixels. 2D-anisotropic total-variation is used for this purpose, and therefore the proposed model is called "TV-UNet". Through experimental results on a relatively large-scale CT segmentation dataset of around 900 images, we show that adding this new regularization term leads to 2\% gain on overall segmentation performance compared to the U-Net model. Our experimental analysis, ranging from visual evaluation of the predicted segmentation results to quantitative assessment of segmentation performance (precision, recall, Dice score, and mIoU) demonstrated great ability to identify COVID-19 associated regions of the lungs, achieving a mIoU rate of over 99\%, and a Dice score of around 86\%.