PairAug: What Can Augmented Image-Text Pairs Do for Radiology?

Current vision-language pre-training (VLP) methodologies predominantly depend on paired image-text datasets, a resource that is challenging to acquire in radiology due to privacy considerations and labelling complexities. Data augmentation provides a practical solution to overcome the issue of data scarcity, however, most augmentation methods exhibit a limited focus, prioritising either image or text augmentation exclusively. Acknowledging this limitation, our objective is to devise a framework capable of concurrently augmenting medical image and text data. We design a Pairwise Augmentation (PairAug) approach that contains an Inter-patient Augmentation (InterAug) branch and an Intra-patient Augmentation (IntraAug) branch. Specifically, the InterAug branch of our approach generates radiology images using synthesised yet plausible reports derived from a Large Language Model (LLM). The generated pairs can be considered a collection of new patient cases since they are artificially created and may not exist in the original dataset. In contrast, the IntraAug branch uses newly generated reports to manipulate images. This process allows us to create new paired data for each individual with diverse medical conditions. Our extensive experiments on various downstream tasks covering medical image classification zero-shot and fine-tuning analysis demonstrate that our PairAug, concurrently expanding both image and text data, substantially outperforms image-/text-only expansion baselines and advanced medical VLP baselines. Our code is released at \url{https://github.com/YtongXie/PairAug}.

Learning with Diversification from Block Sparse Signal

This paper introduces a novel prior called Diversified Block Sparse Prior to characterize the widespread block sparsity phenomenon in real-world data. By allowing diversification on variance and correlation matrix, we effectively address the sensitivity issue of existing block sparse learning methods to pre-defined block information, which enables adaptive block estimation while mitigating the risk of overfitting. Based on this, a diversified block sparse Bayesian learning method (DivSBL) is proposed, utilizing EM algorithm and dual ascent method for hyperparameter estimation. Moreover, we establish the global and local optimality theory of our model. Experiments validate the advantages of DivSBL over existing algorithms.

MAST: Video Polyp Segmentation with a Mixture-Attention Siamese Transformer

Accurate segmentation of polyps from colonoscopy videos is of great significance to polyp treatment and early prevention of colorectal cancer. However, it is challenging due to the difficulties associated with modelling long-range spatio-temporal relationships within a colonoscopy video. In this paper, we address this challenging task with a novel Mixture-Attention Siamese Transformer (MAST), which explicitly models the long-range spatio-temporal relationships with a mixture-attention mechanism for accurate polyp segmentation. Specifically, we first construct a Siamese transformer architecture to jointly encode paired video frames for their feature representations. We then design a mixture-attention module to exploit the intra-frame and inter-frame correlations, enhancing the features with rich spatio-temporal relationships. Finally, the enhanced features are fed to two parallel decoders for predicting the segmentation maps. To the best of our knowledge, our MAST is the first transformer model dedicated to video polyp segmentation. Extensive experiments on the large-scale SUN-SEG benchmark demonstrate the superior performance of MAST in comparison with the cutting-edge competitors. Our code is publicly available at https://github.com/Junqing-Yang/MAST.

Part to Whole: Collaborative Prompting for Surgical Instrument Segmentation

Foundation models like the Segment Anything Model (SAM) have demonstrated promise in generic object segmentation. However, directly applying SAM to surgical instrument segmentation presents key challenges. First, SAM relies on per-frame point-or-box prompts which complicate surgeon-computer interaction. Also, SAM yields suboptimal performance on segmenting surgical instruments, owing to insufficient surgical data in its pre-training as well as the complex structure and fine-grained details of various surgical instruments. To address these challenges, in this paper, we investigate text promptable surgical instrument segmentation and propose SP-SAM (SurgicalPart-SAM), a novel efficient-tuning approach that integrates surgical instrument structure knowledge with the generic segmentation knowledge of SAM. Specifically, we achieve this by proposing (1) collaborative prompts in the text form "[part name] of [instrument category name]" that decompose instruments into fine-grained parts; (2) a Cross-Modal Prompt Encoder that encodes text prompts jointly with visual embeddings into discriminative part-level representations; and (3) a Part-to-Whole Selective Fusion and a Hierarchical Decoding strategy that selectively assemble the part-level representations into a whole for accurate instrument segmentation. Built upon them, SP-SAM acquires a better capability to comprehend surgical instrument structures and distinguish between various categories. Extensive experiments on both the EndoVis2018 and EndoVis2017 datasets demonstrate SP-SAM's state-of-the-art performance with minimal tunable parameters. Code is at https://github.com/wenxi-yue/SurgicalPart-SAM.

SegRap2023: A Benchmark of Organs-at-Risk and Gross Tumor Volume Segmentation for Radiotherapy Planning of Nasopharyngeal Carcinoma

Radiation therapy is a primary and effective NasoPharyngeal Carcinoma (NPC) treatment strategy. The precise delineation of Gross Tumor Volumes (GTVs) and Organs-At-Risk (OARs) is crucial in radiation treatment, directly impacting patient prognosis. Previously, the delineation of GTVs and OARs was performed by experienced radiation oncologists. Recently, deep learning has achieved promising results in many medical image segmentation tasks. However, for NPC OARs and GTVs segmentation, few public datasets are available for model development and evaluation. To alleviate this problem, the SegRap2023 challenge was organized in conjunction with MICCAI2023 and presented a large-scale benchmark for OAR and GTV segmentation with 400 Computed Tomography (CT) scans from 200 NPC patients, each with a pair of pre-aligned non-contrast and contrast-enhanced CT scans. The challenge's goal was to segment 45 OARs and 2 GTVs from the paired CT scans. In this paper, we detail the challenge and analyze the solutions of all participants. The average Dice similarity coefficient scores for all submissions ranged from 76.68\% to 86.70\%, and 70.42\% to 73.44\% for OARs and GTVs, respectively. We conclude that the segmentation of large-size OARs is well-addressed, and more efforts are needed for GTVs and small-size or thin-structure OARs. The benchmark will remain publicly available here: https://segrap2023.grand-challenge.org

Think Twice Before Selection: Federated Evidential Active Learning for Medical Image Analysis with Domain Shifts

Federated learning facilitates the collaborative learning of a global model across multiple distributed medical institutions without centralizing data. Nevertheless, the expensive cost of annotation on local clients remains an obstacle to effectively utilizing local data. To mitigate this issue, federated active learning methods suggest leveraging local and global model predictions to select a relatively small amount of informative local data for annotation. However, existing methods mainly focus on all local data sampled from the same domain, making them unreliable in realistic medical scenarios with domain shifts among different clients. In this paper, we make the first attempt to assess the informativeness of local data derived from diverse domains and propose a novel methodology termed Federated Evidential Active Learning (FEAL) to calibrate the data evaluation under domain shift. Specifically, we introduce a Dirichlet prior distribution in both local and global models to treat the prediction as a distribution over the probability simplex and capture both aleatoric and epistemic uncertainties by using the Dirichlet-based evidential model. Then we employ the epistemic uncertainty to calibrate the aleatoric uncertainty. Afterward, we design a diversity relaxation strategy to reduce data redundancy and maintain data diversity. Extensive experiments and analyses are conducted to show the superiority of FEAL over the state-of-the-art active learning methods and the efficiency of FEAL under the federated active learning framework.

Each Test Image Deserves A Specific Prompt: Continual Test-Time Adaptation for 2D Medical Image Segmentation

Distribution shift widely exists in medical images acquired from different medical centres and poses a significant obstacle to deploying the pre-trained semantic segmentation model in real-world applications. Test-time adaptation has proven its effectiveness in tackling the cross-domain distribution shift during inference. However, most existing methods achieve adaptation by updating the pre-trained models, rendering them susceptible to error accumulation and catastrophic forgetting when encountering a series of distribution shifts (i.e., under the continual test-time adaptation setup). To overcome these challenges caused by updating the models, in this paper, we freeze the pre-trained model and propose the Visual Prompt-based Test-Time Adaptation (VPTTA) method to train a specific prompt for each test image to align the statistics in the batch normalization layers. Specifically, we present the low-frequency prompt, which is lightweight with only a few parameters and can be effectively trained in a single iteration. To enhance prompt initialization, we equip VPTTA with a memory bank to benefit the current prompt from previous ones. Additionally, we design a warm-up mechanism, which mixes source and target statistics to construct warm-up statistics, thereby facilitating the training process. Extensive experiments demonstrate the superiority of our VPTTA over other state-of-the-art methods on two medical image segmentation benchmark tasks. The code and weights of pre-trained source models are available at https://github.com/Chen-Ziyang/VPTTA.

Continual Self-supervised Learning: Towards Universal Multi-modal Medical Data Representation Learning

Self-supervised learning is an efficient pre-training method for medical image analysis. However, current research is mostly confined to specific-modality data pre-training, consuming considerable time and resources without achieving universality across different modalities. A straightforward solution is combining all modality data for joint self-supervised pre-training, which poses practical challenges. Firstly, our experiments reveal conflicts in representation learning as the number of modalities increases. Secondly, multi-modal data collected in advance cannot cover all real-world scenarios. In this paper, we reconsider versatile self-supervised learning from the perspective of continual learning and propose MedCoSS, a continuous self-supervised learning approach for multi-modal medical data. Unlike joint self-supervised learning, MedCoSS assigns different modality data to different training stages, forming a multi-stage pre-training process. To balance modal conflicts and prevent catastrophic forgetting, we propose a rehearsal-based continual learning method. We introduce the k-means sampling strategy to retain data from previous modalities and rehearse it when learning new modalities. Instead of executing the pretext task on buffer data, a feature distillation strategy and an intra-modal mixup strategy are applied to these data for knowledge retention. We conduct continuous self-supervised pre-training on a large-scale multi-modal unlabeled dataset, including clinical reports, X-rays, CT scans, MRI scans, and pathological images. Experimental results demonstrate MedCoSS's exceptional generalization ability across nine downstream datasets and its significant scalability in integrating new modality data. Code and pre-trained weight are available at https://github.com/yeerwen/MedCoSS.

SAMv2: A Unified Framework for Learning Appearance, Semantic and Cross-Modality Anatomical Embeddings

Identifying anatomical structures (e.g., lesions or landmarks) in medical images plays a fundamental role in medical image analysis. As an exemplar-based landmark detection method, Self-supervised Anatomical eMbedding (SAM) learns a discriminative embedding for each voxel in the image and has shown promising results on various tasks. However, SAM still faces challenges in: (1) differentiating voxels with similar appearance but different semantic meanings (\textit{e.g.}, two adjacent structures without clear borders); (2) matching voxels with similar semantics but markedly different appearance (e.g., the same vessel before and after contrast injection); and (3) cross-modality matching (e.g., CT-MRI registration). To overcome these challenges, we propose SAMv2, which is a unified framework designed to learn appearance, semantic, and cross-modality anatomical embeddings. Specifically, SAMv2 incorporates three key innovations: (1) semantic embedding learning with prototypical contrastive loss; (2) a fixed-point-based matching strategy; and (3) an iterative approach for cross-modality embedding learning. We thoroughly evaluated SAMv2 across three tasks, including one-shot landmark detection, lesion tracking on longitudinal CT scans, and CT-MRI affine/rigid registration with varying field of view. Our results suggest that SAMv2 outperforms SAM and other state-of-the-art methods, offering a robust and versatile approach for landmark based medical image analysis tasks. Code and trained models are available at: https://github.com/alibaba-damo-academy/self-supervised-anatomical-embedding-v2

Segment Together: A Versatile Paradigm for Semi-Supervised Medical Image Segmentation

Annotation scarcity has become a major obstacle for training powerful deep-learning models for medical image segmentation, restricting their deployment in clinical scenarios. To address it, semi-supervised learning by exploiting abundant unlabeled data is highly desirable to boost the model training. However, most existing works still focus on limited medical tasks and underestimate the potential of learning across diverse tasks and multiple datasets. Therefore, in this paper, we introduce a \textbf{Ver}satile \textbf{Semi}-supervised framework (VerSemi) to point out a new perspective that integrates various tasks into a unified model with a broad label space, to exploit more unlabeled data for semi-supervised medical image segmentation. Specifically, we introduce a dynamic task-prompted design to segment various targets from different datasets. Next, this unified model is used to identify the foreground regions from all labeled data, to capture cross-dataset semantics. Particularly, we create a synthetic task with a cutmix strategy to augment foreground targets within the expanded label space. To effectively utilize unlabeled data, we introduce a consistency constraint. This involves aligning aggregated predictions from various tasks with those from the synthetic task, further guiding the model in accurately segmenting foreground regions during training. We evaluated our VerSemi model on four public benchmarking datasets. Extensive experiments demonstrated that VerSemi can consistently outperform the second-best method by a large margin (e.g., an average 2.69\% Dice gain on four datasets), setting new SOTA performance for semi-supervised medical image segmentation. The code will be released.