RadFusion: Benchmarking Performance and Fairness for Multimodal Pulmonary Embolism Detection from CT and EHR

Despite the routine use of electronic health record (EHR) data by radiologists to contextualize clinical history and inform image interpretation, the majority of deep learning architectures for medical imaging are unimodal, i.e., they only learn features from pixel-level information. Recent research revealing how race can be recovered from pixel data alone highlights the potential for serious biases in models which fail to account for demographics and other key patient attributes. Yet the lack of imaging datasets which capture clinical context, inclusive of demographics and longitudinal medical history, has left multimodal medical imaging underexplored. To better assess these challenges, we present RadFusion, a multimodal, benchmark dataset of 1794 patients with corresponding EHR data and high-resolution computed tomography (CT) scans labeled for pulmonary embolism. We evaluate several representative multimodal fusion models and benchmark their fairness properties across protected subgroups, e.g., gender, race/ethnicity, age. Our results suggest that integrating imaging and EHR data can improve classification performance and robustness without introducing large disparities in the true positive rate between population groups.

Rethinking Architecture Design for Tackling Data Heterogeneity in Federated Learning

Federated learning is an emerging research paradigm enabling collaborative training of machine learning models among different organizations while keeping data private at each institution. Despite recent progress, there remain fundamental challenges such as lack of convergence and potential for catastrophic forgetting in federated learning across real-world heterogeneous devices. In this paper, we demonstrate that attention-based architectures (e.g., Transformers) are fairly robust to distribution shifts and hence improve federated learning over heterogeneous data. Concretely, we conduct the first rigorous empirical investigation of different neural architectures across a range of federated algorithms, real-world benchmarks, and heterogeneous data splits. Our experiments show that simply replacing convolutional networks with Transformers can greatly reduce catastrophic forgetting of previous devices, accelerate convergence, and reach a better global model, especially when dealing with heterogeneous data. We will release our code and pretrained models at https://github.com/Liangqiong/ViT-FL-main to encourage future exploration in robust architectures as an alternative to current research efforts on the optimization front.

Learning Inductive Attention Guidance for Partially Supervised Pancreatic Ductal Adenocarcinoma Prediction

Pancreatic ductal adenocarcinoma (PDAC) is the third most common cause of cancer death in the United States. Predicting tumors like PDACs (including both classification and segmentation) from medical images by deep learning is becoming a growing trend, but usually a large number of annotated data are required for training, which is very labor-intensive and time-consuming. In this paper, we consider a partially supervised setting, where cheap image-level annotations are provided for all the training data, and the costly per-voxel annotations are only available for a subset of them. We propose an Inductive Attention Guidance Network (IAG-Net) to jointly learn a global image-level classifier for normal/PDAC classification and a local voxel-level classifier for semi-supervised PDAC segmentation. We instantiate both the global and the local classifiers by multiple instance learning (MIL), where the attention guidance, indicating roughly where the PDAC regions are, is the key to bridging them: For global MIL based normal/PDAC classification, attention serves as a weight for each instance (voxel) during MIL pooling, which eliminates the distraction from the background; For local MIL based semi-supervised PDAC segmentation, the attention guidance is inductive, which not only provides bag-level pseudo-labels to training data without per-voxel annotations for MIL training, but also acts as a proxy of an instance-level classifier. Experimental results show that our IAG-Net boosts PDAC segmentation accuracy by more than 5% compared with the state-of-the-arts.

DualNorm-UNet: Incorporating Global and Local Statistics for Robust Medical Image Segmentation

Batch Normalization (BN) is one of the key components for accelerating network training, and has been widely adopted in the medical image analysis field. However, BN only calculates the global statistics at the batch level, and applies the same affine transformation uniformly across all spatial coordinates, which would suppress the image contrast of different semantic structures. In this paper, we propose to incorporate the semantic class information into normalization layers, so that the activations corresponding to different regions (i.e., classes) can be modulated differently. We thus develop a novel DualNorm-UNet, to concurrently incorporate both global image-level statistics and local region-wise statistics for network normalization. Specifically, the local statistics are integrated by adaptively modulating the activations along different class regions via the learned semantic masks in the normalization layer. Compared with existing methods, our approach exploits semantic knowledge at normalization and yields more discriminative features for robust segmentation results. More importantly, our network demonstrates superior abilities in capturing domain-invariant information from multiple domains (institutions) of medical data. Extensive experiments show that our proposed DualNorm-UNet consistently improves the performance on various segmentation tasks, even in the face of more complex and variable data distributions. Code is available at https://github.com/lambert-x/DualNorm-Unet.

TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation

Medical image segmentation is an essential prerequisite for developing healthcare systems, especially for disease diagnosis and treatment planning. On various medical image segmentation tasks, the u-shaped architecture, also known as U-Net, has become the de-facto standard and achieved tremendous success. However, due to the intrinsic locality of convolution operations, U-Net generally demonstrates limitations in explicitly modeling long-range dependency. Transformers, designed for sequence-to-sequence prediction, have emerged as alternative architectures with innate global self-attention mechanisms, but can result in limited localization abilities due to insufficient low-level details. In this paper, we propose TransUNet, which merits both Transformers and U-Net, as a strong alternative for medical image segmentation. On one hand, the Transformer encodes tokenized image patches from a convolution neural network (CNN) feature map as the input sequence for extracting global contexts. On the other hand, the decoder upsamples the encoded features which are then combined with the high-resolution CNN feature maps to enable precise localization. We argue that Transformers can serve as strong encoders for medical image segmentation tasks, with the combination of U-Net to enhance finer details by recovering localized spatial information. TransUNet achieves superior performances to various competing methods on different medical applications including multi-organ segmentation and cardiac segmentation. Code and models are available at https://github.com/Beckschen/TransUNet.

Can Temporal Information Help with Contrastive Self-Supervised Learning?

Leveraging temporal information has been regarded as essential for developing video understanding models. However, how to properly incorporate temporal information into the recent successful instance discrimination based contrastive self-supervised learning (CSL) framework remains unclear. As an intuitive solution, we find that directly applying temporal augmentations does not help, or even impair video CSL in general. This counter-intuitive observation motivates us to re-design existing video CSL frameworks, for better integration of temporal knowledge. To this end, we present Temporal-aware Contrastive self-supervised learningTaCo, as a general paradigm to enhance video CSL. Specifically, TaCo selects a set of temporal transformations not only as strong data augmentation but also to constitute extra self-supervision for video understanding. By jointly contrasting instances with enriched temporal transformations and learning these transformations as self-supervised signals, TaCo can significantly enhance unsupervised video representation learning. For instance, TaCo demonstrates consistent improvement in downstream classification tasks over a list of backbones and CSL approaches. Our best model achieves 85.1% (UCF-101) and 51.6% (HMDB-51) top-1 accuracy, which is a 3% and 2.4% relative improvement over the previous state-of-the-art.

Volumetric Medical Image Segmentation: A 3D Deep Coarse-to-fine Framework and Its Adversarial Examples

Although deep neural networks have been a dominant method for many 2D vision tasks, it is still challenging to apply them to 3D tasks, such as medical image segmentation, due to the limited amount of annotated 3D data and limited computational resources. In this chapter, by rethinking the strategy to apply 3D Convolutional Neural Networks to segment medical images, we propose a novel 3D-based coarse-to-fine framework to efficiently tackle these challenges. The proposed 3D-based framework outperforms their 2D counterparts by a large margin since it can leverage the rich spatial information along all three axes. We further analyze the threat of adversarial attacks on the proposed framework and show how to defense against the attack. We conduct experiments on three datasets, the NIH pancreas dataset, the JHMI pancreas dataset and the JHMI pathological cyst dataset, where the first two and the last one contain healthy and pathological pancreases respectively, and achieve the current state-of-the-art in terms of Dice-Sorensen Coefficient (DSC) on all of them. Especially, on the NIH pancreas segmentation dataset, we outperform the previous best by an average of over $2\%$, and the worst case is improved by $7\%$ to reach almost $70\%$, which indicates the reliability of our framework in clinical applications.

Domain Adaptive Relational Reasoning for 3D Multi-Organ Segmentation

In this paper, we present a novel unsupervised domain adaptation (UDA) method, named Domain Adaptive Relational Reasoning (DARR), to generalize 3D multi-organ segmentation models to medical data collected from different scanners and/or protocols (domains). Our method is inspired by the fact that the spatial relationship between internal structures in medical images is relatively fixed, e.g., a spleen is always located at the tail of a pancreas, which serves as a latent variable to transfer the knowledge shared across multiple domains. We formulate the spatial relationship by solving a jigsaw puzzle task, i.e., recovering a CT scan from its shuffled patches, and jointly train it with the organ segmentation task. To guarantee the transferability of the learned spatial relationship to multiple domains, we additionally introduce two schemes: 1) Employing a super-resolution network also jointly trained with the segmentation model to standardize medical images from different domain to a certain spatial resolution; 2) Adapting the spatial relationship for a test image by test-time jigsaw puzzle training. Experimental results show that our method improves the performance by 29.60\% DSC on target datasets on average without using any data from the target domain during training.

Neural Architecture Search for Lightweight Non-Local Networks

Non-Local (NL) blocks have been widely studied in various vision tasks. However, it has been rarely explored to embed the NL blocks in mobile neural networks, mainly due to the following challenges: 1) NL blocks generally have heavy computation cost which makes it difficult to be applied in applications where computational resources are limited, and 2) it is an open problem to discover an optimal configuration to embed NL blocks into mobile neural networks. We propose AutoNL to overcome the above two obstacles. Firstly, we propose a Lightweight Non-Local (LightNL) block by squeezing the transformation operations and incorporating compact features. With the novel design choices, the proposed LightNL block is 400x computationally cheaper} than its conventional counterpart without sacrificing the performance. Secondly, by relaxing the structure of the LightNL block to be differentiable during training, we propose an efficient neural architecture search algorithm to learn an optimal configuration of LightNL blocks in an end-to-end manner. Notably, using only 32 GPU hours, the searched AutoNL model achieves 77.7% top-1 accuracy on ImageNet under a typical mobile setting (350M FLOPs), significantly outperforming previous mobile models including MobileNetV2 (+5.7%), FBNet (+2.8%) and MnasNet (+2.1%). Code and models are available at https://github.com/LiYingwei/AutoNL.

Detecting Pancreatic Adenocarcinoma in Multi-phase CT Scans via Alignment Ensemble

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers among population. Screening for PDACs in dynamic contrast-enhanced CT is beneficial for early diagnose. In this paper, we investigate the problem of automated detecting PDACs in multi-phase (arterial and venous) CT scans. Multiple phases provide more information than single phase, but they are unaligned and inhomogeneous in texture, making it difficult to combine cross-phase information seamlessly. We study multiple phase alignment strategies, i.e., early alignment (image registration), late alignment (high-level feature registration) and slow alignment (multi-level feature registration), and suggest an ensemble of all these alignments as a promising way to boost the performance of PDAC detection. We provide an extensive empirical evaluation on two PDAC datasets and show that the proposed alignment ensemble significantly outperforms previous state-of-the-art approaches, illustrating strong potential for clinical use.