Influence of High-Performance Image-to-Image Translation Networks on Clinical Visual Assessment and Outcome Prediction: Utilizing Ultrasound to MRI Translation in Prostate Cancer

Purpose: This study examines the core traits of image-to-image translation (I2I) networks, focusing on their effectiveness and adaptability in everyday clinical settings. Methods: We have analyzed data from 794 patients diagnosed with prostate cancer (PCa), using ten prominent 2D/3D I2I networks to convert ultrasound (US) images into MRI scans. We also introduced a new analysis of Radiomic features (RF) via the Spearman correlation coefficient to explore whether networks with high performance (SSIM>85%) could detect subtle RFs. Our study further examined synthetic images by 7 invited physicians. As a final evaluation study, we have investigated the improvement that are achieved using the synthetic MRI data on two traditional machine learning and one deep learning method. Results: In quantitative assessment, 2D-Pix2Pix network substantially outperformed the other 7 networks, with an average SSIM~0.855. The RF analysis revealed that 76 out of 186 RFs were identified using the 2D-Pix2Pix algorithm alone, although half of the RFs were lost during the translation process. A detailed qualitative review by 7 medical doctors noted a deficiency in low-level feature recognition in I2I tasks. Furthermore, the study found that synthesized image-based classification outperformed US image-based classification with an average accuracy and AUC~0.93. Conclusion: This study showed that while 2D-Pix2Pix outperformed cutting-edge networks in low-level feature discovery and overall error and similarity metrics, it still requires improvement in low-level feature performance, as highlighted by Group 3. Further, the study found using synthetic image-based classification outperformed original US image-based methods.

MNet-SAt: A Multiscale Network with Spatial-enhanced Attention for Segmentation of Polyps in Colonoscopy

Objective: To develop a novel deep learning framework for the automated segmentation of colonic polyps in colonoscopy images, overcoming the limitations of current approaches in preserving precise polyp boundaries, incorporating multi-scale features, and modeling spatial dependencies that accurately reflect the intricate and diverse morphology of polyps. Methods: To address these limitations, we propose a novel Multiscale Network with Spatial-enhanced Attention (MNet-SAt) for polyp segmentation in colonoscopy images. This framework incorporates four key modules: Edge-Guided Feature Enrichment (EGFE) preserves edge information for improved boundary quality; Multi-Scale Feature Aggregator (MSFA) extracts and aggregates multi-scale features across channel spatial dimensions, focusing on salient regions; Spatial-Enhanced Attention (SEAt) captures spatial-aware global dependencies within the multi-scale aggregated features, emphasizing the region of interest; and Channel-Enhanced Atrous Spatial Pyramid Pooling (CE-ASPP) resamples and recalibrates attentive features across scales. Results: We evaluated MNet-SAt on the Kvasir-SEG and CVC-ClinicDB datasets, achieving Dice Similarity Coefficients of 96.61% and 98.60%, respectively. Conclusion: Both quantitative (DSC) and qualitative assessments highlight MNet-SAt's superior performance and generalization capabilities compared to existing methods. Significance: MNet-SAt's high accuracy in polyp segmentation holds promise for improving clinical workflows in early polyp detection and more effective treatment, contributing to reduced colorectal cancer mortality rates.

An Attention-Guided Deep Learning Approach for Classifying 39 Skin Lesion Types

The skin, as the largest organ of the human body, is vulnerable to a diverse array of conditions collectively known as skin lesions, which encompass various dermatoses. Diagnosing these lesions presents significant challenges for medical practitioners due to the subtle visual differences that are often imperceptible to the naked eye. While not all skin lesions are life-threatening, certain types can act as early indicators of severe diseases, including skin cancers, underscoring the critical need for timely and accurate diagnostic methods. Deep learning algorithms have demonstrated remarkable potential in facilitating the early detection and prognosis of skin lesions. This study advances the field by curating a comprehensive and diverse dataset comprising 39 categories of skin lesions, synthesized from five publicly available datasets. Using this dataset, the performance of five state-of-the-art deep learning models -- MobileNetV2, Xception, InceptionV3, EfficientNetB1, and Vision Transformer - is rigorously evaluated. To enhance the accuracy and robustness of these models, attention mechanisms such as the Efficient Channel Attention (ECA) and the Convolutional Block Attention Module (CBAM) are incorporated into their architectures. Comprehensive evaluation across multiple performance metrics reveals that the Vision Transformer model integrated with CBAM outperforms others, achieving an accuracy of 93.46%, precision of 94%, recall of 93%, F1-score of 93%, and specificity of 93.67%. These results underscore the significant potential of the proposed system in supporting medical professionals with accurate and efficient prognostic tools for diagnosing a broad spectrum of skin lesions. The dataset and code used in this study can be found at https://github.com/akabircs/Skin-Lesions-Classification.

Revisiting Lesion Tracking in 3D Total Body Photography

Melanoma is the most deadly form of skin cancer. Tracking the evolution of nevi and detecting new lesions across the body is essential for the early detection of melanoma. Despite prior work on longitudinal tracking of skin lesions in 3D total body photography, there are still several challenges, including 1) low accuracy for finding correct lesion pairs across scans, 2) sensitivity to noisy lesion detection, and 3) lack of large-scale datasets with numerous annotated lesion pairs. We propose a framework that takes in a pair of 3D textured meshes, matches lesions in the context of total body photography, and identifies unmatchable lesions. We start by computing correspondence maps bringing the source and target meshes to a template mesh. Using these maps to define source/target signals over the template domain, we construct a flow field aligning the mapped signals. The initial correspondence maps are then refined by advecting forward/backward along the vector field. Finally, lesion assignment is performed using the refined correspondence maps. We propose the first large-scale dataset for skin lesion tracking with 25K lesion pairs across 198 subjects. The proposed method achieves a success rate of 89.9% (at 10 mm criterion) for all pairs of annotated lesions and a matching accuracy of 98.2% for subjects with more than 200 lesions.

Advancing Pancreatic Cancer Prediction with a Next Visit Token Prediction Head on top of Med-BERT

Background: Recently, numerous foundation models pretrained on extensive data have demonstrated efficacy in disease prediction using Electronic Health Records (EHRs). However, there remains some unanswered questions on how to best utilize such models especially with very small fine-tuning cohorts. Methods: We utilized Med-BERT, an EHR-specific foundation model, and reformulated the disease binary prediction task into a token prediction task and a next visit mask token prediction task to align with Med-BERT's pretraining task format in order to improve the accuracy of pancreatic cancer (PaCa) prediction in both few-shot and fully supervised settings. Results: The reformulation of the task into a token prediction task, referred to as Med-BERT-Sum, demonstrates slightly superior performance in both few-shot scenarios and larger data samples. Furthermore, reformulating the prediction task as a Next Visit Mask Token Prediction task (Med-BERT-Mask) significantly outperforms the conventional Binary Classification (BC) prediction task (Med-BERT-BC) by 3% to 7% in few-shot scenarios with data sizes ranging from 10 to 500 samples. These findings highlight that aligning the downstream task with Med-BERT's pretraining objectives substantially enhances the model's predictive capabilities, thereby improving its effectiveness in predicting both rare and common diseases. Conclusion: Reformatting disease prediction tasks to align with the pretraining of foundation models enhances prediction accuracy, leading to earlier detection and timely intervention. This approach improves treatment effectiveness, survival rates, and overall patient outcomes for PaCa and potentially other cancers.

Divide and Conquer: Grounding a Bleeding Areas in Gastrointestinal Image with Two-Stage Model

Accurate detection and segmentation of gastrointestinal bleeding are critical for diagnosing diseases such as peptic ulcers and colorectal cancer. This study proposes a two-stage framework that decouples classification and grounding to address the inherent challenges posed by traditional Multi-Task Learning models, which jointly optimizes classification and segmentation. Our approach separates these tasks to achieve targeted optimization for each. The model first classifies images as bleeding or non-bleeding, thereby isolating subsequent grounding from inter-task interference and label heterogeneity. To further enhance performance, we incorporate Stochastic Weight Averaging and Test-Time Augmentation, which improve model robustness against domain shifts and annotation inconsistencies. Our method is validated on the Auto-WCEBleedGen Challenge V2 Challenge dataset and achieving second place. Experimental results demonstrate significant improvements in classification accuracy and segmentation precision, especially on sequential datasets with consistent visual patterns. This study highlights the practical benefits of a two-stage strategy for medical image analysis and sets a new standard for GI bleeding detection and segmentation. Our code is publicly available at this GitHub repository.

SegCol Challenge: Semantic Segmentation for Tools and Fold Edges in Colonoscopy data

Colorectal cancer (CRC) remains a leading cause of cancer-related deaths worldwide, with polyp removal being an effective early screening method. However, navigating the colon for thorough polyp detection poses significant challenges. To advance camera navigation in colonoscopy, we propose the Semantic Segmentation for Tools and Fold Edges in Colonoscopy (SegCol) Challenge. This challenge introduces a dataset from the EndoMapper repository, featuring manually annotated, pixel-level semantic labels for colon folds and endoscopic tools across selected frames from 96 colonoscopy videos. By providing fold edges as anatomical landmarks and depth discontinuity information from both fold and tool labels, the dataset is aimed to improve depth perception and localization methods. Hosted as part of the Endovis Challenge at MICCAI 2024, SegCol aims to drive innovation in colonoscopy navigation systems. Details are available at https://www.synapse.org/Synapse:syn54124209/wiki/626563, and code resources at https://github.com/surgical-vision/segcol_challenge .

Unified Local and Global Attention Interaction Modeling for Vision Transformers

We present a novel method that extends the self-attention mechanism of a vision transformer (ViT) for more accurate object detection across diverse datasets. ViTs show strong capability for image understanding tasks such as object detection, segmentation, and classification. This is due in part to their ability to leverage global information from interactions among visual tokens. However, the self-attention mechanism in ViTs are limited because they do not allow visual tokens to exchange local or global information with neighboring features before computing global attention. This is problematic because tokens are treated in isolation when attending (matching) to other tokens, and valuable spatial relationships are overlooked. This isolation is further compounded by dot-product similarity operations that make tokens from different semantic classes appear visually similar. To address these limitations, we introduce two modifications to the traditional self-attention framework; a novel aggressive convolution pooling strategy for local feature mixing, and a new conceptual attention transformation to facilitate interaction and feature exchange between semantic concepts. Experimental results demonstrate that local and global information exchange among visual features before self-attention significantly improves performance on challenging object detection tasks and generalizes across multiple benchmark datasets and challenging medical datasets. We publish source code and a novel dataset of cancerous tumors (chimeric cell clusters).

Interpretable Droplet Digital PCR Assay for Trustworthy Molecular Diagnostics

Accurate molecular quantification is essential for advancing research and diagnostics in fields such as infectious diseases, cancer biology, and genetic disorders. Droplet digital PCR (ddPCR) has emerged as a gold standard for achieving absolute quantification. While computational ddPCR technologies have advanced significantly, achieving automatic interpretation and consistent adaptability across diverse operational environments remains a challenge. To address these limitations, we introduce the intelligent interpretable droplet digital PCR (I2ddPCR) assay, a comprehensive framework integrating front-end predictive models (for droplet segmentation and classification) with GPT-4o multimodal large language model (MLLM, for context-aware explanations and recommendations) to automate and enhance ddPCR image analysis. This approach surpasses the state-of-the-art models, affording 99.05% accuracy in processing complex ddPCR images containing over 300 droplets per image with varying signal-to-noise ratios (SNRs). By combining specialized neural networks and large language models, the I2ddPCR assay offers a robust and adaptable solution for absolute molecular quantification, achieving a sensitivity capable of detecting low-abundance targets as low as 90.32 copies/{\mu}L. Furthermore, it improves model's transparency through detailed explanation and troubleshooting guidance, empowering users to make informed decisions. This innovative framework has the potential to benefit molecular diagnostics, disease research, and clinical applications, especially in resource-constrained settings.

Performance of a large language model-Artificial Intelligence based chatbot for counseling patients with sexually transmitted infections and genital diseases

Introduction: Global burden of sexually transmitted infections (STIs) is rising out of proportion to specialists. Current chatbots like ChatGPT are not tailored for handling STI-related concerns out of the box. We developed Otiz, an Artificial Intelligence-based (AI-based) chatbot platform designed specifically for STI detection and counseling, and assessed its performance. Methods: Otiz employs a multi-agent system architecture based on GPT4-0613, leveraging large language model (LLM) and Deterministic Finite Automaton principles to provide contextually relevant, medically accurate, and empathetic responses. Its components include modules for general STI information, emotional recognition, Acute Stress Disorder detection, and psychotherapy. A question suggestion agent operates in parallel. Four STIs (anogenital warts, herpes, syphilis, urethritis/cervicitis) and 2 non-STIs (candidiasis, penile cancer) were evaluated using prompts mimicking patient language. Each prompt was independently graded by two venereologists conversing with Otiz as patient actors on 6 criteria using Numerical Rating Scale ranging from 0 (poor) to 5 (excellent). Results: Twenty-three venereologists did 60 evaluations of 30 prompts. Across STIs, Otiz scored highly on diagnostic accuracy (4.1-4.7), overall accuracy (4.3-4.6), correctness of information (5.0), comprehensibility (4.2-4.4), and empathy (4.5-4.8). However, relevance scores were lower (2.9-3.6), suggesting some redundancy. Diagnostic scores for non-STIs were lower (p=0.038). Inter-observer agreement was strong, with differences greater than 1 point occurring in only 12.7% of paired evaluations. Conclusions: AI conversational agents like Otiz can provide accurate, correct, discrete, non-judgmental, readily accessible and easily understandable STI-related information in an empathetic manner, and can alleviate the burden on healthcare systems.