Interactive medical image segmentation refers to the accurate segmentation of the target of interest through interaction (e.g., click) between the user and the image. It has been widely studied in recent years as it is less dependent on abundant annotated data and more flexible than fully automated segmentation. However, current studies have not fully explored user-provided prompt information (e.g., points), including the knowledge mined in one interaction, and the relationship between multiple interactions. Thus, in this paper, we introduce a novel framework equipped with prompt enhancement, called PE-MED, for interactive medical image segmentation. First, we introduce a Self-Loop strategy to generate warm initial segmentation results based on the first prompt. It can prevent the highly unfavorable scenarios, such as encountering a blank mask as the initial input after the first interaction. Second, we propose a novel Prompt Attention Learning Module (PALM) to mine useful prompt information in one interaction, enhancing the responsiveness of the network to user clicks. Last, we build a Time Series Information Propagation (TSIP) mechanism to extract the temporal relationships between multiple interactions and increase the model stability. Comparative experiments with other state-of-the-art (SOTA) medical image segmentation algorithms show that our method exhibits better segmentation accuracy and stability.
Ultrasound (US) imaging is indispensable in clinical practice. To diagnose certain diseases, sonographers must observe corresponding dynamic anatomic structures to gather comprehensive information. However, the limited availability of specific US video cases causes teaching difficulties in identifying corresponding diseases, which potentially impacts the detection rate of such cases. The synthesis of US videos may represent a promising solution to this issue. Nevertheless, it is challenging to accurately animate the intricate motion of dynamic anatomic structures while preserving image fidelity. To address this, we present a novel online feature-decoupling framework called OnUVS for high-fidelity US video synthesis. Our highlights can be summarized by four aspects. First, we introduced anatomic information into keypoint learning through a weakly-supervised training strategy, resulting in improved preservation of anatomical integrity and motion while minimizing the labeling burden. Second, to better preserve the integrity and textural information of US images, we implemented a dual-decoder that decouples the content and textural features in the generator. Third, we adopted a multiple-feature discriminator to extract a comprehensive range of visual cues, thereby enhancing the sharpness and fine details of the generated videos. Fourth, we constrained the motion trajectories of keypoints during online learning to enhance the fluidity of generated videos. Our validation and user studies on in-house echocardiographic and pelvic floor US videos showed that OnUVS synthesizes US videos with high fidelity.
Localization of the narrowest position of the vessel and corresponding vessel and remnant vessel delineation in carotid ultrasound (US) are essential for carotid stenosis grading (CSG) in clinical practice. However, the pipeline is time-consuming and tough due to the ambiguous boundaries of plaque and temporal variation. To automatize this procedure, a large number of manual delineations are usually required, which is not only laborious but also not reliable given the annotation difficulty. In this study, we present the first video classification framework for automatic CSG. Our contribution is three-fold. First, to avoid the requirement of laborious and unreliable annotation, we propose a novel and effective video classification network for weakly-supervised CSG. Second, to ease the model training, we adopt an inflation strategy for the network, where pre-trained 2D convolution weights can be adapted into the 3D counterpart in our network for an effective warm start. Third, to enhance the feature discrimination of the video, we propose a novel attention-guided multi-dimension fusion (AMDF) transformer encoder to model and integrate global dependencies within and across spatial and temporal dimensions, where two lightweight cross-dimensional attention mechanisms are designed. Our approach is extensively validated on a large clinically collected carotid US video dataset, demonstrating state-of-the-art performance compared with strong competitors.
Deep classifiers may encounter significant performance degradation when processing unseen testing data from varying centers, vendors, and protocols. Ensuring the robustness of deep models against these domain shifts is crucial for their widespread clinical application. In this study, we propose a novel approach called Fourier Test-time Adaptation (FTTA), which employs a dual-adaptation design to integrate input and model tuning, thereby jointly improving the model robustness. The main idea of FTTA is to build a reliable multi-level consistency measurement of paired inputs for achieving self-correction of prediction. Our contribution is two-fold. First, we encourage consistency in global features and local attention maps between the two transformed images of the same input. Here, the transformation refers to Fourier-based input adaptation, which can transfer one unseen image into source style to reduce the domain gap. Furthermore, we leverage style-interpolated images to enhance the global and local features with learnable parameters, which can smooth the consistency measurement and accelerate convergence. Second, we introduce a regularization technique that utilizes style interpolation consistency in the frequency space to encourage self-consistency in the logit space of the model output. This regularization provides strong self-supervised signals for robustness enhancement. FTTA was extensively validated on three large classification datasets with different modalities and organs. Experimental results show that FTTA is general and outperforms other strong state-of-the-art methods.
The Segment Anything Model (SAM) is the first foundation model for general image segmentation. It designed a novel promotable segmentation task, ensuring zero-shot image segmentation using the pre-trained model via two main modes including automatic everything and manual prompt. SAM has achieved impressive results on various natural image segmentation tasks. However, medical image segmentation (MIS) is more challenging due to the complex modalities, fine anatomical structures, uncertain and complex object boundaries, and wide-range object scales. Meanwhile, zero-shot and efficient MIS can well reduce the annotation time and boost the development of medical image analysis. Hence, SAM seems to be a potential tool and its performance on large medical datasets should be further validated. We collected and sorted 52 open-source datasets, and built a large medical segmentation dataset with 16 modalities, 68 objects, and 553K slices. We conducted a comprehensive analysis of different SAM testing strategies on the so-called COSMOS 553K dataset. Extensive experiments validate that SAM performs better with manual hints like points and boxes for object perception in medical images, leading to better performance in prompt mode compared to everything mode. Additionally, SAM shows remarkable performance in some specific objects and modalities, but is imperfect or even totally fails in other situations. Finally, we analyze the influence of different factors (e.g., the Fourier-based boundary complexity and size of the segmented objects) on SAM's segmentation performance. Extensive experiments validate that SAM's zero-shot segmentation capability is not sufficient to ensure its direct application to the MIS.
Deep segmentation models often face the failure risks when the testing image presents unseen distributions. Improving model robustness against these risks is crucial for the large-scale clinical application of deep models. In this study, inspired by human learning cycle, we propose a novel online reflective learning framework (RefSeg) to improve segmentation robustness. Based on the reflection-on-action conception, our RefSeg firstly drives the deep model to take action to obtain semantic segmentation. Then, RefSeg triggers the model to reflect itself. Because making deep models realize their segmentation failures during testing is challenging, RefSeg synthesizes a realistic proxy image from the semantic mask to help deep models build intuitive and effective reflections. This proxy translates and emphasizes the segmentation flaws. By maximizing the structural similarity between the raw input and the proxy, the reflection-on-action loop is closed with segmentation robustness improved. RefSeg runs in the testing phase and is general for segmentation models. Extensive validation on three medical image segmentation tasks with a public cardiac MR dataset and two in-house large ultrasound datasets show that our RefSeg remarkably improves model robustness and reports state-of-the-art performance over strong competitors.
Ultrasound (US) is widely used for its advantages of real-time imaging, radiation-free and portability. In clinical practice, analysis and diagnosis often rely on US sequences rather than a single image to obtain dynamic anatomical information. This is challenging for novices to learn because practicing with adequate videos from patients is clinically unpractical. In this paper, we propose a novel framework to synthesize high-fidelity US videos. Specifically, the synthesis videos are generated by animating source content images based on the motion of given driving videos. Our highlights are three-fold. First, leveraging the advantages of self- and fully-supervised learning, our proposed system is trained in weakly-supervised manner for keypoint detection. These keypoints then provide vital information for handling complex high dynamic motions in US videos. Second, we decouple content and texture learning using the dual decoders to effectively reduce the model learning difficulty. Last, we adopt the adversarial training strategy with GAN losses for further improving the sharpness of the generated videos, narrowing the gap between real and synthesis videos. We validate our method on a large in-house pelvic dataset with high dynamic motion. Extensive evaluation metrics and user study prove the effectiveness of our proposed method.
Regression learning is classic and fundamental for medical image analysis. It provides the continuous mapping for many critical applications, like the attribute estimation, object detection, segmentation and non-rigid registration. However, previous studies mainly took the case-wise criteria, like the mean square errors, as the optimization objectives. They ignored the very important population-wise correlation criterion, which is exactly the final evaluation metric in many tasks. In this work, we propose to revisit the classic regression tasks with novel investigations on directly optimizing the fine-grained correlation losses. We mainly explore two complementary correlation indexes as learnable losses: Pearson linear correlation (PLC) and Spearman rank correlation (SRC). The contributions of this paper are two folds. First, for the PLC on global level, we propose a strategy to make it robust against the outliers and regularize the key distribution factors. These efforts significantly stabilize the learning and magnify the efficacy of PLC. Second, for the SRC on local level, we propose a coarse-to-fine scheme to ease the learning of the exact ranking order among samples. Specifically, we convert the learning for the ranking of samples into the learning of similarity relationships among samples. We extensively validate our method on two typical ultrasound image regression tasks, including the image quality assessment and bio-metric measurement. Experiments prove that, with the fine-grained guidance in directly optimizing the correlation, the regression performances are significantly improved. Our proposed correlation losses are general and can be extended to more important applications.