Dermoscopic Dark Corner Artifacts Removal: Friend or Foe?

One of the more significant obstacles in classification of skin cancer is the presence of artifacts. This paper investigates the effect of dark corner artifacts, which result from the use of dermoscopes, on the performance of a deep learning binary classification task. Previous research attempted to remove and inpaint dark corner artifacts, with the intention of creating an ideal condition for models. However, such research has been shown to be inconclusive due to lack of available datasets labelled with dark corner artifacts and detailed analysis and discussion. To address these issues, we label 10,250 skin lesion images from publicly available datasets and introduce a balanced dataset with an equal number of melanoma and non-melanoma cases. The training set comprises 6126 images without artifacts, and the testing set comprises 4124 images with dark corner artifacts. We conduct three experiments to provide new understanding on the effects of dark corner artifacts, including inpainted and synthetically generated examples, on a deep learning method. Our results suggest that introducing synthetic dark corner artifacts which have been superimposed onto the training set improved model performance, particularly in terms of the true negative rate. This indicates that deep learning learnt to ignore dark corner artifacts, rather than treating it as melanoma, when dark corner artifacts were introduced into the training set. Further, we propose a new approach to quantifying heatmaps indicating network focus using a root mean square measure of the brightness intensity in the different regions of the heatmaps. This paper provides a new guideline for skin lesions analysis with an emphasis on reproducibility.

Venn Diagram Multi-label Class Interpretation of Diabetic Foot Ulcer with Color and Sharpness Enhancement

DFU is a severe complication of diabetes that can lead to amputation of the lower limb if not treated properly. Inspired by the 2021 Diabetic Foot Ulcer Grand Challenge, researchers designed automated multi-class classification of DFU, including infection, ischaemia, both of these conditions, and none of these conditions. However, it remains a challenge as classification accuracy is still not satisfactory. This paper proposes a Venn Diagram interpretation of multi-label CNN-based method, utilizing different image enhancement strategies, to improve the multi-class DFU classification. We propose to reduce the four classes into two since both class wounds can be interpreted as the simultaneous occurrence of infection and ischaemia and none class wounds as the absence of infection and ischaemia. We introduce a novel Venn Diagram representation block in the classifier to interpret all four classes from these two classes. To make our model more resilient, we propose enhancing the perceptual quality of DFU images, particularly blurry or inconsistently lit DFU images, by performing color and sharpness enhancements on them. We also employ a fine-tuned optimization technique, adaptive sharpness aware minimization, to improve the CNN model generalization performance. The proposed method is evaluated on the test dataset of DFUC2021, containing 5,734 images and the results are compared with the top-3 winning entries of DFUC2021. Our proposed approach outperforms these existing approaches and achieves Macro-Average F1, Recall and Precision scores of 0.6592, 0.6593, and 0.6652, respectively.Additionally, We perform ablation studies and image quality measurements to further interpret our proposed method. This proposed method will benefit patients with DFUs since it tackles the inconsistencies in captured images and can be employed for a more robust remote DFU wound classification.

Quantifying the Effect of Image Similarity on Diabetic Foot Ulcer Classification

This research conducts an investigation on the effect of visually similar images within a publicly available diabetic foot ulcer dataset when training deep learning classification networks. The presence of binary-identical duplicate images in datasets used to train deep learning algorithms is a well known issue that can introduce unwanted bias which can degrade network performance. However, the effect of visually similar non-identical images is an under-researched topic, and has so far not been investigated in any diabetic foot ulcer studies. We use an open-source fuzzy algorithm to identify groups of increasingly similar images in the Diabetic Foot Ulcers Challenge 2021 (DFUC2021) training dataset. Based on each similarity threshold, we create new training sets that we use to train a range of deep learning multi-class classifiers. We then evaluate the performance of the best performing model on the DFUC2021 test set. Our findings show that the model trained on the training set with the 80\% similarity threshold images removed achieved the best performance using the InceptionResNetV2 network. This model showed improvements in F1-score, precision, and recall of 0.023, 0.029, and 0.013, respectively. These results indicate that highly similar images can contribute towards the presence of performance degrading bias within the Diabetic Foot Ulcers Challenge 2021 dataset, and that the removal of images that are 80\% similar from the training set can help to boost classification performance.

Diabetic Foot Ulcer Grand Challenge 2022 Summary

The Diabetic Foot Ulcer Challenge 2022 focused on the task of diabetic foot ulcer segmentation, based on the work completed in previous DFU challenges. The challenge provided 4000 images of full-view foot ulcer images together with corresponding delineation of ulcer regions. This paper provides an overview of the challenge, a summary of the methods proposed by the challenge participants, the results obtained from each technique, and a comparison of the challenge results. The best-performing network was a modified HarDNet-MSEG, with a Dice score of 0.7287.

Why is the winner the best?

International benchmarking competitions have become fundamental for the comparative performance assessment of image analysis methods. However, little attention has been given to investigating what can be learnt from these competitions. Do they really generate scientific progress? What are common and successful participation strategies? What makes a solution superior to a competing method? To address this gap in the literature, we performed a multi-center study with all 80 competitions that were conducted in the scope of IEEE ISBI 2021 and MICCAI 2021. Statistical analyses performed based on comprehensive descriptions of the submitted algorithms linked to their rank as well as the underlying participation strategies revealed common characteristics of winning solutions. These typically include the use of multi-task learning (63%) and/or multi-stage pipelines (61%), and a focus on augmentation (100%), image preprocessing (97%), data curation (79%), and postprocessing (66%). The "typical" lead of a winning team is a computer scientist with a doctoral degree, five years of experience in biomedical image analysis, and four years of experience in deep learning. Two core general development strategies stood out for highly-ranked teams: the reflection of the metrics in the method design and the focus on analyzing and handling failure cases. According to the organizers, 43% of the winning algorithms exceeded the state of the art but only 11% completely solved the respective domain problem. The insights of our study could help researchers (1) improve algorithm development strategies when approaching new problems, and (2) focus on open research questions revealed by this work.

Biomedical image analysis competitions: The state of current participation practice

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

AAU-net: An Adaptive Attention U-net for Breast Lesions Segmentation in Ultrasound Images

Various deep learning methods have been proposed to segment breast lesion from ultrasound images. However, similar intensity distributions, variable tumor morphology and blurred boundaries present challenges for breast lesions segmentation, especially for malignant tumors with irregular shapes. Considering the complexity of ultrasound images, we develop an adaptive attention U-net (AAU-net) to segment breast lesions automatically and stably from ultrasound images. Specifically, we introduce a hybrid adaptive attention module, which mainly consists of a channel self-attention block and a spatial self-attention block, to replace the traditional convolution operation. Compared with the conventional convolution operation, the design of the hybrid adaptive attention module can help us capture more features under different receptive fields. Different from existing attention mechanisms, the hybrid adaptive attention module can guide the network to adaptively select more robust representation in channel and space dimensions to cope with more complex breast lesions segmentation. Extensive experiments with several state-of-the-art deep learning segmentation methods on three public breast ultrasound datasets show that our method has better performance on breast lesion segmentation. Furthermore, robustness analysis and external experiments demonstrate that our proposed AAU-net has better generalization performance on the segmentation of breast lesions. Moreover, the hybrid adaptive attention module can be flexibly applied to existing network frameworks.

Translating Clinical Delineation of Diabetic Foot Ulcers into Machine Interpretable Segmentation

Diabetic foot ulcer is a severe condition that requires close monitoring and management. For training machine learning methods to auto-delineate the ulcer, clinical staff must provide ground truth annotations. In this paper, we propose a new diabetic foot ulcers dataset, namely DFUC2022, the largest segmentation dataset where ulcer regions were manually delineated by clinicians. We assess whether the clinical delineations are machine interpretable by deep learning networks or if image processing refined contour should be used. By providing benchmark results using a selection of popular deep learning algorithms, we draw new insights into the limitations of DFU wound delineation and report on the associated issues. This paper provides some observations on baseline models to facilitate DFUC2022 Challenge in conjunction with MICCAI 2022. The leaderboard will be ranked by Dice score, where the best FCN-based method is 0.5708 and DeepLabv3+ achieved the best score of 0.6277. This paper demonstrates that image processing using refined contour as ground truth can provide better agreement with machine predicted results. DFUC2022 will be released on the 27th April 2022.

V-LinkNet: Learning Contextual Inpainting Across Latent Space of Generative Adversarial Network

Deep learning methods outperform traditional methods in image inpainting. In order to generate contextual textures, researchers are still working to improve on existing methods and propose models that can extract, propagate, and reconstruct features similar to ground-truth regions. Furthermore, the lack of a high-quality feature transfer mechanism in deeper layers contributes to persistent aberrations on generated inpainted regions. To address these limitations, we propose the V-LinkNet cross-space learning strategy network. To improve learning on contextualised features, we design a loss model that employs both encoders. In addition, we propose a recursive residual transition layer (RSTL). The RSTL extracts high-level semantic information and propagates it down layers. Finally, we compare inpainting performance on the same face with different masks and on different faces with the same masks. To improve image inpainting reproducibility, we propose a standard protocol to overcome biases with various masks and images. We investigate the V-LinkNet components using experimental methods. Our result surpasses the state of the art when evaluated on the CelebA-HQ with the standard protocol. In addition, our model can generalise well when evaluated on Paris Street View, and Places2 datasets with the standard protocol.

Development of Diabetic Foot Ulcer Datasets: An Overview

This paper provides conceptual foundation and procedures used in the development of diabetic foot ulcer datasets over the past decade, with a timeline to demonstrate progress. We conduct a survey on data capturing methods for foot photographs, an overview of research in developing private and public datasets, the related computer vision tasks (detection, segmentation and classification), the diabetic foot ulcer challenges and the future direction of the development of the datasets. We report the distribution of dataset users by country and year. Our aim is to share the technical challenges that we encountered together with good practices in dataset development, and provide motivation for other researchers to participate in data sharing in this domain.