Universal and Extensible Language-Vision Models for Organ Segmentation and Tumor Detection from Abdominal Computed Tomography

The advancement of artificial intelligence (AI) for organ segmentation and tumor detection is propelled by the growing availability of computed tomography (CT) datasets with detailed, per-voxel annotations. However, these AI models often struggle with flexibility for partially annotated datasets and extensibility for new classes due to limitations in the one-hot encoding, architectural design, and learning scheme. To overcome these limitations, we propose a universal, extensible framework enabling a single model, termed Universal Model, to deal with multiple public datasets and adapt to new classes (e.g., organs/tumors). Firstly, we introduce a novel language-driven parameter generator that leverages language embeddings from large language models, enriching semantic encoding compared with one-hot encoding. Secondly, the conventional output layers are replaced with lightweight, class-specific heads, allowing Universal Model to simultaneously segment 25 organs and six types of tumors and ease the addition of new classes. We train our Universal Model on 3,410 CT volumes assembled from 14 publicly available datasets and then test it on 6,173 CT volumes from four external datasets. Universal Model achieves first place on six CT tasks in the Medical Segmentation Decathlon (MSD) public leaderboard and leading performance on the Beyond The Cranial Vault (BTCV) dataset. In summary, Universal Model exhibits remarkable computational efficiency (6x faster than other dataset-specific models), demonstrates strong generalization across different hospitals, transfers well to numerous downstream tasks, and more importantly, facilitates the extensibility to new classes while alleviating the catastrophic forgetting of previously learned classes. Codes, models, and datasets are available at https://github.com/ljwztc/CLIP-Driven-Universal-Model

Exploiting Structural Consistency of Chest Anatomy for Unsupervised Anomaly Detection in Radiography Images

Radiography imaging protocols focus on particular body regions, therefore producing images of great similarity and yielding recurrent anatomical structures across patients. Exploiting this structured information could potentially ease the detection of anomalies from radiography images. To this end, we propose a Simple Space-Aware Memory Matrix for In-painting and Detecting anomalies from radiography images (abbreviated as SimSID). We formulate anomaly detection as an image reconstruction task, consisting of a space-aware memory matrix and an in-painting block in the feature space. During the training, SimSID can taxonomize the ingrained anatomical structures into recurrent visual patterns, and in the inference, it can identify anomalies (unseen/modified visual patterns) from the test image. Our SimSID surpasses the state of the arts in unsupervised anomaly detection by +8.0%, +5.0%, and +9.9% AUC scores on ZhangLab, COVIDx, and CheXpert benchmark datasets, respectively. Code: https://github.com/MrGiovanni/SimSID

From Pixel to Cancer: Cellular Automata in Computed Tomography

AI for cancer detection encounters the bottleneck of data scarcity, annotation difficulty, and low prevalence of early tumors. Tumor synthesis seeks to create artificial tumors in medical images, which can greatly diversify the data and annotations for AI training. However, current tumor synthesis approaches are not applicable across different organs due to their need for specific expertise and design. This paper establishes a set of generic rules to simulate tumor development. Each cell (pixel) is initially assigned a state between zero and ten to represent the tumor population, and a tumor can be developed based on three rules to describe the process of growth, invasion, and death. We apply these three generic rules to simulate tumor development--from pixel to cancer--using cellular automata. We then integrate the tumor state into the original computed tomography (CT) images to generate synthetic tumors across different organs. This tumor synthesis approach allows for sampling tumors at multiple stages and analyzing tumor-organ interaction. Clinically, a reader study involving three expert radiologists reveals that the synthetic tumors and their developing trajectories are convincingly realistic. Technically, we generate tumors at varied stages in 9,262 raw, unlabeled CT images sourced from 68 hospitals worldwide. The performance in segmenting tumors in the liver, pancreas, and kidneys exceeds prevailing literature benchmarks, underlining the immense potential of tumor synthesis, especially for earlier cancer detection. The code and models are available at https://github.com/MrGiovanni/Pixel2Cancer

Radiative Gaussian Splatting for Efficient X-ray Novel View Synthesis

X-ray is widely applied for transmission imaging due to its stronger penetration than natural light. When rendering novel view X-ray projections, existing methods mainly based on NeRF suffer from long training time and slow inference speed. In this paper, we propose a 3D Gaussian splatting-based framework, namely X-Gaussian, for X-ray novel view synthesis. Firstly, we redesign a radiative Gaussian point cloud model inspired by the isotropic nature of X-ray imaging. Our model excludes the influence of view direction when learning to predict the radiation intensity of 3D points. Based on this model, we develop a Differentiable Radiative Rasterization (DRR) with CUDA implementation. Secondly, we customize an Angle-pose Cuboid Uniform Initialization (ACUI) strategy that directly uses the parameters of the X-ray scanner to compute the camera information and then uniformly samples point positions within a cuboid enclosing the scanned object. Experiments show that our X-Gaussian outperforms state-of-the-art methods by 6.5 dB while enjoying less than 15% training time and over 73x inference speed. The application on sparse-view CT reconstruction also reveals the practical values of our method. Code and models will be publicly available at https://github.com/caiyuanhao1998/X-Gaussian . A video demo of the training process visualization is at https://www.youtube.com/watch?v=gDVf_Ngeghg .

Leveraging AI Predicted and Expert Revised Annotations in Interactive Segmentation: Continual Tuning or Full Training?

Interactive segmentation, an integration of AI algorithms and human expertise, premises to improve the accuracy and efficiency of curating large-scale, detailed-annotated datasets in healthcare. Human experts revise the annotations predicted by AI, and in turn, AI improves its predictions by learning from these revised annotations. This interactive process continues to enhance the quality of annotations until no major revision is needed from experts. The key challenge is how to leverage AI predicted and expert revised annotations to iteratively improve the AI. Two problems arise: (1) The risk of catastrophic forgetting--the AI tends to forget the previously learned classes if it is only retrained using the expert revised classes. (2) Computational inefficiency when retraining the AI using both AI predicted and expert revised annotations; moreover, given the dominant AI predicted annotations in the dataset, the contribution of newly revised annotations--often account for a very small fraction--to the AI training remains marginal. This paper proposes Continual Tuning to address the problems from two perspectives: network design and data reuse. Firstly, we design a shared network for all classes followed by class-specific networks dedicated to individual classes. To mitigate forgetting, we freeze the shared network for previously learned classes and only update the class-specific network for revised classes. Secondly, we reuse a small fraction of data with previous annotations to avoid over-computing. The selection of such data relies on the importance estimate of each data. The importance score is computed by combining the uncertainty and consistency of AI predictions. Our experiments demonstrate that Continual Tuning achieves a speed 16x greater than repeatedly training AI from scratch without compromising the performance.

Towards Generalizable Tumor Synthesis

Tumor synthesis enables the creation of artificial tumors in medical images, facilitating the training of AI models for tumor detection and segmentation. However, success in tumor synthesis hinges on creating visually realistic tumors that are generalizable across multiple organs and, furthermore, the resulting AI models being capable of detecting real tumors in images sourced from different domains (e.g., hospitals). This paper made a progressive stride toward generalizable tumor synthesis by leveraging a critical observation: early-stage tumors (< 2cm) tend to have similar imaging characteristics in computed tomography (CT), whether they originate in the liver, pancreas, or kidneys. We have ascertained that generative AI models, e.g., Diffusion Models, can create realistic tumors generalized to a range of organs even when trained on a limited number of tumor examples from only one organ. Moreover, we have shown that AI models trained on these synthetic tumors can be generalized to detect and segment real tumors from CT volumes, encompassing a broad spectrum of patient demographics, imaging protocols, and healthcare facilities.

Gemini: A Family of Highly Capable Multimodal Models

This report introduces a new family of multimodal models, Gemini, that exhibit remarkable capabilities across image, audio, video, and text understanding. The Gemini family consists of Ultra, Pro, and Nano sizes, suitable for applications ranging from complex reasoning tasks to on-device memory-constrained use-cases. Evaluation on a broad range of benchmarks shows that our most-capable Gemini Ultra model advances the state of the art in 30 of 32 of these benchmarks - notably being the first model to achieve human-expert performance on the well-studied exam benchmark MMLU, and improving the state of the art in every one of the 20 multimodal benchmarks we examined. We believe that the new capabilities of Gemini models in cross-modal reasoning and language understanding will enable a wide variety of use cases and we discuss our approach toward deploying them responsibly to users.

Structure-Aware Sparse-View X-ray 3D Reconstruction

X-ray, known for its ability to reveal internal structures of objects, is expected to provide richer information for 3D reconstruction than visible light. Yet, existing neural radiance fields (NeRF) algorithms overlook this important nature of X-ray, leading to their limitations in capturing structural contents of imaged objects. In this paper, we propose a framework, Structure-Aware X-ray Neural Radiodensity Fields (SAX-NeRF), for sparse-view X-ray 3D reconstruction. Firstly, we design a Line Segment-based Transformer (Lineformer) as the backbone of SAX-NeRF. Linefomer captures internal structures of objects in 3D space by modeling the dependencies within each line segment of an X-ray. Secondly, we present a Masked Local-Global (MLG) ray sampling strategy to extract contextual and geometric information in 2D projection. Plus, we collect a larger-scale dataset X3D covering wider X-ray applications. Experiments on X3D show that SAX-NeRF surpasses previous NeRF-based methods by 12.56 and 2.49 dB on novel view synthesis and CT reconstruction. Code, models, and data will be released at https://github.com/caiyuanhao1998/SAX-NeRF

Synthetic Data as Validation

This study leverages synthetic data as a validation set to reduce overfitting and ease the selection of the best model in AI development. While synthetic data have been used for augmenting the training set, we find that synthetic data can also significantly diversify the validation set, offering marked advantages in domains like healthcare, where data are typically limited, sensitive, and from out-domain sources (i.e., hospitals). In this study, we illustrate the effectiveness of synthetic data for early cancer detection in computed tomography (CT) volumes, where synthetic tumors are generated and superimposed onto healthy organs, thereby creating an extensive dataset for rigorous validation. Using synthetic data as validation can improve AI robustness in both in-domain and out-domain test sets. Furthermore, we establish a new continual learning framework that continuously trains AI models on a stream of out-domain data with synthetic tumors. The AI model trained and validated in dynamically expanding synthetic data can consistently outperform models trained and validated exclusively on real-world data. Specifically, the DSC score for liver tumor segmentation improves from 26.7% (95% CI: 22.6%-30.9%) to 34.5% (30.8%-38.2%) when evaluated on an in-domain dataset and from 31.1% (26.0%-36.2%) to 35.4% (32.1%-38.7%) on an out-domain dataset. Importantly, the performance gain is particularly significant in identifying very tiny liver tumors (radius < 5mm) in CT volumes, with Sensitivity improving from 33.1% to 55.4% on an in-domain dataset and 33.9% to 52.3% on an out-domain dataset, justifying the efficacy in early detection of cancer. The application of synthetic data, from both training and validation perspectives, underlines a promising avenue to enhance AI robustness when dealing with data from varying domains.

Acquiring Weak Annotations for Tumor Localization in Temporal and Volumetric Data

Creating large-scale and well-annotated datasets to train AI algorithms is crucial for automated tumor detection and localization. However, with limited resources, it is challenging to determine the best type of annotations when annotating massive amounts of unlabeled data. To address this issue, we focus on polyps in colonoscopy videos and pancreatic tumors in abdominal CT scans; both applications require significant effort and time for pixel-wise annotation due to the high dimensional nature of the data, involving either temporary or spatial dimensions. In this paper, we develop a new annotation strategy, termed Drag&Drop, which simplifies the annotation process to drag and drop. This annotation strategy is more efficient, particularly for temporal and volumetric imaging, than other types of weak annotations, such as per-pixel, bounding boxes, scribbles, ellipses, and points. Furthermore, to exploit our Drag&Drop annotations, we develop a novel weakly supervised learning method based on the watershed algorithm. Experimental results show that our method achieves better detection and localization performance than alternative weak annotations and, more importantly, achieves similar performance to that trained on detailed per-pixel annotations. Interestingly, we find that, with limited resources, allocating weak annotations from a diverse patient population can foster models more robust to unseen images than allocating per-pixel annotations for a small set of images. In summary, this research proposes an efficient annotation strategy for tumor detection and localization that is less accurate than per-pixel annotations but useful for creating large-scale datasets for screening tumors in various medical modalities.