Coupling AI and Citizen Science in Creation of Enhanced Training Dataset for Medical Image Segmentation

Recent advancements in medical imaging and artificial intelligence (AI) have greatly enhanced diagnostic capabilities, but the development of effective deep learning (DL) models is still constrained by the lack of high-quality annotated datasets. The traditional manual annotation process by medical experts is time- and resource-intensive, limiting the scalability of these datasets. In this work, we introduce a robust and versatile framework that combines AI and crowdsourcing to improve both the quality and quantity of medical image datasets across different modalities. Our approach utilises a user-friendly online platform that enables a diverse group of crowd annotators to label medical images efficiently. By integrating the MedSAM segmentation AI with this platform, we accelerate the annotation process while maintaining expert-level quality through an algorithm that merges crowd-labelled images. Additionally, we employ pix2pixGAN, a generative AI model, to expand the training dataset with synthetic images that capture realistic morphological features. These methods are combined into a cohesive framework designed to produce an enhanced dataset, which can serve as a universal pre-processing pipeline to boost the training of any medical deep learning segmentation model. Our results demonstrate that this framework significantly improves model performance, especially when training data is limited.

Beyond the Hype: A dispassionate look at vision-language models in medical scenario

Recent advancements in Large Vision-Language Models (LVLMs) have demonstrated remarkable capabilities across diverse tasks, garnering significant attention in AI communities. However, their performance and reliability in specialized domains such as medicine remain insufficiently assessed. In particular, most assessments over-concentrate in evaluating VLMs based on simple Visual Question Answering (VQA) on multi-modality data, while ignoring the in-depth characteristic of LVLMs. In this study, we introduce RadVUQA, a novel Radiological Visual Understanding and Question Answering benchmark, to comprehensively evaluate existing LVLMs. RadVUQA mainly validates LVLMs across five dimensions: 1) Anatomical understanding, assessing the models' ability to visually identify biological structures; 2) Multimodal comprehension, which involves the capability of interpreting linguistic and visual instructions to produce desired outcomes; 3) Quantitative and spatial reasoning, evaluating the models' spatial awareness and proficiency in combining quantitative analysis with visual and linguistic information; 4) Physiological knowledge, measuring the models' capability to comprehend functions and mechanisms of organs and systems; and 5) Robustness, which assesses the models' capabilities against unharmonised and synthetic data. The results indicate that both generalized LVLMs and medical-specific LVLMs have critical deficiencies with weak multimodal comprehension and quantitative reasoning capabilities. Our findings reveal the large gap between existing LVLMs and clinicians, highlighting the urgent need for more robust and intelligent LVLMs. The code and dataset will be available after the acceptance of this paper.

CIResDiff: A Clinically-Informed Residual Diffusion Model for Predicting Idiopathic Pulmonary Fibrosis Progression

The progression of Idiopathic Pulmonary Fibrosis (IPF) significantly correlates with higher patient mortality rates. Early detection of IPF progression is critical for initiating timely treatment, which can effectively slow down the advancement of the disease. However, the current clinical criteria define disease progression requiring two CT scans with a one-year interval, presenting a dilemma: a disease progression is identified only after the disease has already progressed. To this end, in this paper, we develop a novel diffusion model to accurately predict the progression of IPF by generating patient's follow-up CT scan from the initial CT scan. Specifically, from the clinical prior knowledge, we tailor improvements to the traditional diffusion model and propose a Clinically-Informed Residual Diffusion model, called CIResDiff. The key innovations of CIResDiff include 1) performing the target region pre-registration to align the lung regions of two CT scans at different time points for reducing the generation difficulty, 2) adopting the residual diffusion instead of traditional diffusion to enable the model focus more on differences (i.e., lesions) between the two CT scans rather than the largely identical anatomical content, and 3) designing the clinically-informed process based on CLIP technology to integrate lung function information which is highly relevant to diagnosis into the reverse process for assisting generation. Extensive experiments on clinical data demonstrate that our approach can outperform state-of-the-art methods and effectively predict the progression of IPF.

A dual-task mutual learning framework for predicting post-thrombectomy cerebral hemorrhage

Ischemic stroke is a severe condition caused by the blockage of brain blood vessels, and can lead to the death of brain tissue due to oxygen deprivation. Thrombectomy has become a common treatment choice for ischemic stroke due to its immediate effectiveness. But, it carries the risk of postoperative cerebral hemorrhage. Clinically, multiple CT scans within 0-72 hours post-surgery are used to monitor for hemorrhage. However, this approach exposes radiation dose to patients, and may delay the detection of cerebral hemorrhage. To address this dilemma, we propose a novel prediction framework for measuring postoperative cerebral hemorrhage using only the patient's initial CT scan. Specifically, we introduce a dual-task mutual learning framework to takes the initial CT scan as input and simultaneously estimates both the follow-up CT scan and prognostic label to predict the occurrence of postoperative cerebral hemorrhage. Our proposed framework incorporates two attention mechanisms, i.e., self-attention and interactive attention. Specifically, the self-attention mechanism allows the model to focus more on high-density areas in the image, which are critical for diagnosis (i.e., potential hemorrhage areas). The interactive attention mechanism further models the dependencies between the interrelated generation and classification tasks, enabling both tasks to perform better than the case when conducted individually. Validated on clinical data, our method can generate follow-up CT scans better than state-of-the-art methods, and achieves an accuracy of 86.37% in predicting follow-up prognostic labels. Thus, our work thus contributes to the timely screening of post-thrombectomy cerebral hemorrhage, and could significantly reform the clinical process of thrombectomy and other similar operations related to stroke.

Artificial Immunofluorescence in a Flash: Rapid Synthetic Imaging from Brightfield Through Residual Diffusion

Immunofluorescent (IF) imaging is crucial for visualizing biomarker expressions, cell morphology and assessing the effects of drug treatments on sub-cellular components. IF imaging needs extra staining process and often requiring cell fixation, therefore it may also introduce artefects and alter endogenouous cell morphology. Some IF stains are expensive or not readily available hence hindering experiments. Recent diffusion models, which synthesise high-fidelity IF images from easy-to-acquire brightfield (BF) images, offer a promising solution but are hindered by training instability and slow inference times due to the noise diffusion process. This paper presents a novel method for the conditional synthesis of IF images directly from BF images along with cell segmentation masks. Our approach employs a Residual Diffusion process that enhances stability and significantly reduces inference time. We performed a critical evaluation against other image-to-image synthesis models, including UNets, GANs, and advanced diffusion models. Our model demonstrates significant improvements in image quality (p<0.05 in MSE, PSNR, and SSIM), inference speed (26 times faster than competing diffusion models), and accurate segmentation results for both nuclei and cell bodies (0.77 and 0.63 mean IOU for nuclei and cell true positives, respectively). This paper is a substantial advancement in the field, providing robust and efficient tools for cell image analysis.

Probing Perfection: The Relentless Art of Meddling for Pulmonary Airway Segmentation from HRCT via a Human-AI Collaboration Based Active Learning Method

In pulmonary tracheal segmentation, the scarcity of annotated data is a prevalent issue in medical segmentation. Additionally, Deep Learning (DL) methods face challenges: the opacity of 'black box' models and the need for performance enhancement. Our Human-Computer Interaction (HCI) based models (RS_UNet, LC_UNet, UUNet, and WD_UNet) address these challenges by combining diverse query strategies with various DL models. We train four HCI models and repeat these steps: (1) Query Strategy: The HCI models select samples that provide the most additional representative information when labeled in each iteration and identify unlabeled samples with the greatest predictive disparity using Wasserstein Distance, Least Confidence, Entropy Sampling, and Random Sampling. (2) Central line correction: Selected samples are used for expert correction of system-generated tracheal central lines in each training round. (3) Update training dataset: Experts update the training dataset after each DL model's training epoch, enhancing the trustworthiness and performance of the models. (4) Model training: The HCI model is trained using the updated dataset and an enhanced UNet version. Experimental results confirm the effectiveness of these HCI-based approaches, showing that WD-UNet, LC-UNet, UUNet, and RS-UNet achieve comparable or superior performance to state-of-the-art DL models. Notably, WD-UNet achieves this with only 15%-35% of the training data, reducing physician annotation time by 65%-85%.

Fuzzy Attention-based Border Rendering Network for Lung Organ Segmentation

Automatic lung organ segmentation on CT images is crucial for lung disease diagnosis. However, the unlimited voxel values and class imbalance of lung organs can lead to false-negative/positive and leakage issues in advanced methods. Additionally, some slender lung organs are easily lost during the recycled down/up-sample procedure, e.g., bronchioles & arterioles, causing severe discontinuity issue. Inspired by these, this paper introduces an effective lung organ segmentation method called Fuzzy Attention-based Border Rendering (FABR) network. Since fuzzy logic can handle the uncertainty in feature extraction, hence the fusion of deep networks and fuzzy sets should be a viable solution for better performance. Meanwhile, unlike prior top-tier methods that operate on all regular dense points, our FABR depicts lung organ regions as cube-trees, focusing only on recycle-sampled border vulnerable points, rendering the severely discontinuous, false-negative/positive organ regions with a novel Global-Local Cube-tree Fusion (GLCF) module. All experimental results, on four challenging datasets of airway & artery, demonstrate that our method can achieve the favorable performance significantly.

When AI Eats Itself: On the Caveats of Data Pollution in the Era of Generative AI

Generative artificial intelligence (AI) technologies and large models are producing realistic outputs across various domains, such as images, text, speech, and music. Creating these advanced generative models requires significant resources, particularly large and high-quality datasets. To minimize training expenses, many algorithm developers use data created by the models themselves as a cost-effective training solution. However, not all synthetic data effectively improve model performance, necessitating a strategic balance in the use of real versus synthetic data to optimize outcomes. Currently, the previously well-controlled integration of real and synthetic data is becoming uncontrollable. The widespread and unregulated dissemination of synthetic data online leads to the contamination of datasets traditionally compiled through web scraping, now mixed with unlabeled synthetic data. This trend portends a future where generative AI systems may increasingly rely blindly on consuming self-generated data, raising concerns about model performance and ethical issues. What will happen if generative AI continuously consumes itself without discernment? What measures can we take to mitigate the potential adverse effects? There is a significant gap in the scientific literature regarding the impact of synthetic data use in generative AI, particularly in terms of the fusion of multimodal information. To address this research gap, this review investigates the consequences of integrating synthetic data blindly on training generative AI on both image and text modalities and explores strategies to mitigate these effects. The goal is to offer a comprehensive view of synthetic data's role, advocating for a balanced approach to its use and exploring practices that promote the sustainable development of generative AI technologies in the era of large models.

Assessing the Efficacy of Invisible Watermarks in AI-Generated Medical Images

AI-generated medical images are gaining growing popularity due to their potential to address the data scarcity challenge in the real world. However, the issue of accurate identification of these synthetic images, particularly when they exhibit remarkable realism with their real copies, remains a concern. To mitigate this challenge, image generators such as DALLE and Imagen, have integrated digital watermarks aimed at facilitating the discernment of synthetic images' authenticity. These watermarks are embedded within the image pixels and are invisible to the human eye while remains their detectability. Nevertheless, a comprehensive investigation into the potential impact of these invisible watermarks on the utility of synthetic medical images has been lacking. In this study, we propose the incorporation of invisible watermarks into synthetic medical images and seek to evaluate their efficacy in the context of downstream classification tasks. Our goal is to pave the way for discussions on the viability of such watermarks in boosting the detectability of synthetic medical images, fortifying ethical standards, and safeguarding against data pollution and potential scams.

Hunting imaging biomarkers in pulmonary fibrosis: Benchmarks of the AIIB23 challenge

Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway trees remains prohibitively time-consuming. While significant efforts have been made towards enhancing airway modelling, current public-available datasets concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023' (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for prognosis, a strong airway-derived biomarker (Hazard ratio>1.5, p<0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers.