Xiuding Cai

Xiuding Cai, Yaoyao Zhu, Dong Miao et al.

In an unpaired setting, lacking sufficient content constraints for image-to-image translation (I2I) tasks, GAN-based approaches are usually prone to model collapse. Current solutions can be divided into two categories, reconstruction-based and Siamese network-based. The former requires that the transformed or transforming image can be perfectly converted back to the original image, which is sometimes too strict and limits the generative performance. The latter involves feeding the original and generated images into a feature extractor and then matching their outputs. This is not efficient enough, and a universal feature extractor is not easily available. In this paper, we propose EnCo, a simple but efficient way to maintain the content by constraining the representational similarity in the latent space of patch-level features from the same stage of the \textbf{En}coder and de\textbf{Co}der of the generator. For the similarity function, we use a simple MSE loss instead of contrastive loss, which is currently widely used in I2I tasks. Benefits from the design, EnCo training is extremely efficient, while the features from the encoder produce a more positive effect on the decoding, leading to more satisfying generations. In addition, we rethink the role played by discriminators in sampling patches and propose a discriminative attention-guided (DAG) patch sampling strategy to replace random sampling. DAG is parameter-free and only requires negligible computational overhead, while significantly improving the performance of the model. Extensive experiments on multiple datasets demonstrate the effectiveness and advantages of EnCo, and we achieve multiple state-of-the-art compared to previous methods. Our code is available at https://github.com/XiudingCai/EnCo-pytorch.

Linjie Fu, Xia Li, Xiuding Cai et al.

Cone Beam CT (CBCT) plays a crucial role in Adaptive Radiation Therapy (ART) by accurately providing radiation treatment when organ anatomy changes occur. However, CBCT images suffer from scatter noise and artifacts, making relying solely on CBCT for precise dose calculation and accurate tissue localization challenging. Therefore, there is a need to improve CBCT image quality and Hounsfield Unit (HU) accuracy while preserving anatomical structures. To enhance the role and application value of CBCT in ART, we propose an energy-guided diffusion model (EGDiff) and conduct experiments on a chest tumor dataset to generate synthetic CT (sCT) from CBCT. The experimental results demonstrate impressive performance with an average absolute error of 26.87$\pm$6.14 HU, a structural similarity index measurement of 0.850$\pm$0.03, a peak signal-to-noise ratio of the sCT of 19.83$\pm$1.39 dB, and a normalized cross-correlation of the sCT of 0.874$\pm$0.04. These results indicate that our method outperforms state-of-the-art unsupervised synthesis methods in accuracy and visual quality, producing superior sCT images.

Xiuding Cai, Xueyao Wang, Sen Wang et al.

Intraoperative monitoring and prediction of vital signs are critical for ensuring patient safety and improving surgical outcomes. Despite recent advances in deep learning models for medical time-series forecasting, several challenges persist, including the lack of standardized benchmarks, incomplete data, and limited cross-center validation. To address these challenges, we introduce VitalBench, a novel benchmark specifically designed for intraoperative vital sign prediction. VitalBench includes data from over 4,000 surgeries across two independent medical centers, offering three evaluation tracks: complete data, incomplete data, and cross-center generalization. This framework reflects the real-world complexities of clinical practice, minimizing reliance on extensive preprocessing and incorporating masked loss techniques for robust and unbiased model evaluation. By providing a standardized and unified platform for model development and comparison, VitalBench enables researchers to focus on architectural innovation while ensuring consistency in data handling. This work lays the foundation for advancing predictive models for intraoperative vital sign forecasting, ensuring that these models are not only accurate but also robust and adaptable across diverse clinical environments. Our code and data are available at https://github.com/XiudingCai/VitalBench.

Xiuding Cai, Jiao Chen, Yaoyao Zhu et al.

Automated anesthesia promises to enable more precise and personalized anesthetic administration and free anesthesiologists from repetitive tasks, allowing them to focus on the most critical aspects of a patient's surgical care. Current research has typically focused on creating simulated environments from which agents can learn. These approaches have demonstrated good experimental results, but are still far from clinical application. In this paper, Policy Constraint Q-Learning (PCQL), a data-driven reinforcement learning algorithm for solving the problem of learning anesthesia strategies on real clinical datasets, is proposed. Conservative Q-Learning was first introduced to alleviate the problem of Q function overestimation in an offline context. A policy constraint term is added to agent training to keep the policy distribution of the agent and the anesthesiologist consistent to ensure safer decisions made by the agent in anesthesia scenarios. The effectiveness of PCQL was validated by extensive experiments on a real clinical anesthesia dataset. Experimental results show that PCQL is predicted to achieve higher gains than the baseline approach while maintaining good agreement with the reference dose given by the anesthesiologist, using less total dose, and being more responsive to the patient's vital signs. In addition, the confidence intervals of the agent were investigated, which were able to cover most of the clinical decisions of the anesthesiologist. Finally, an interpretable method, SHAP, was used to analyze the contributing components of the model predictions to increase the transparency of the model.

Yaoyao Zhu, Xiuding Cai, Xueyao Wang et al.

Data augmentation is a crucial regularization technique for deep neural networks, particularly in medical image classification. Mainstream data augmentation (DA) methods are usually applied at the image level. Due to the specificity and diversity of medical imaging, expertise is often required to design effective DA strategies, and improper augmentation operations can degrade model performance. Although automatic augmentation methods exist, they are computationally intensive. Semantic data augmentation can implemented by translating features in feature space. However, over-translation may violate the image label. To address these issues, we propose \emph{Bayesian Random Semantic Data Augmentation} (BSDA), a computationally efficient and handcraft-free feature-level DA method. BSDA uses variational Bayesian to estimate the distribution of the augmentable magnitudes, and then a sample from this distribution is added to the original features to perform semantic data augmentation. We performed experiments on nine 2D and five 3D medical image datasets. Experimental results show that BSDA outperforms current DA methods. Additionally, BSDA can be easily assembled into CNNs or Transformers as a plug-and-play module, improving the network's performance. The code is available online at \url{https://github.com/YaoyaoZhu19/BSDA}.

Yaoyao Zhu, Xiuding Cai, Yingkai Wang et al.

Deep learning models excel in computer vision tasks but often fail to generalize to out-of-distribution (OOD) domains. Invariant Risk Minimization (IRM) aims to address OOD generalization by learning domain-invariant features. However, IRM struggles with datasets exhibiting significant diversity shifts. While data augmentation methods like Mixup and Semantic Data Augmentation (SDA) enhance diversity, they risk over-augmentation and label instability. To address these challenges, we propose a domain-shared Semantic Data Augmentation (SDA) module, a novel implementation of Variance Risk Minimization (VRM) designed to enhance dataset diversity while maintaining label consistency. We further provide a Rademacher complexity analysis, establishing a tighter generalization error bound compared to baseline methods. Extensive evaluations on OOD benchmarks, including PACS, VLCS, OfficeHome, and TerraIncognita, demonstrate consistent performance improvements over state-of-the-art domain generalization methods.

Xiuding Cai, Yaoyao Zhu, Linjie Fu et al.

Regularization is essential in deep learning to enhance generalization and mitigate overfitting. However, conventional techniques often rely on heuristics, making them less reliable or effective across diverse settings. We propose Self Identity Mapping (SIM), a simple yet effective, data-intrinsic regularization framework that leverages an inverse mapping mechanism to enhance representation learning. By reconstructing the input from its transformed output, SIM reduces information loss during forward propagation and facilitates smoother gradient flow. To address computational inefficiencies, We instantiate SIM as $ ρ\text{SIM} $ by incorporating patch-level feature sampling and projection-based method to reconstruct latent features, effectively lowering complexity. As a model-agnostic, task-agnostic regularizer, SIM can be seamlessly integrated as a plug-and-play module, making it applicable to different network architectures and tasks. We extensively evaluate $ρ\text{SIM}$ across three tasks: image classification, few-shot prompt learning, and domain generalization. Experimental results show consistent improvements over baseline methods, highlighting $ρ\text{SIM}$'s ability to enhance representation learning across various tasks. We also demonstrate that $ρ\text{SIM}$ is orthogonal to existing regularization methods, boosting their effectiveness. Moreover, our results confirm that $ρ\text{SIM}$ effectively preserves semantic information and enhances performance in dense-to-dense tasks, such as semantic segmentation and image translation, as well as in non-visual domains including audio classification and time series anomaly detection. The code is publicly available at https://github.com/XiudingCai/SIM-pytorch.

Linjie Fu, Xia Li, Xiuding Cai et al.

Radiation therapy is crucial in cancer treatment. Experienced experts typically iteratively generate high-quality dose distribution maps, forming the basis for excellent radiation therapy plans. Therefore, automated prediction of dose distribution maps is significant in expediting the treatment process and providing a better starting point for developing radiation therapy plans. With the remarkable results of diffusion models in predicting high-frequency regions of dose distribution maps, dose prediction methods based on diffusion models have been extensively studied. However, existing methods mainly utilize CNNs or Transformers as denoising networks. CNNs lack the capture of global receptive fields, resulting in suboptimal prediction performance. Transformers excel in global modeling but face quadratic complexity with image size, resulting in significant computational overhead. To tackle these challenges, we introduce a novel diffusion model, MD-Dose, based on the Mamba architecture for predicting radiation therapy dose distribution in thoracic cancer patients. In the forward process, MD-Dose adds Gaussian noise to dose distribution maps to obtain pure noise images. In the backward process, MD-Dose utilizes a noise predictor based on the Mamba to predict the noise, ultimately outputting the dose distribution maps. Furthermore, We develop a Mamba encoder to extract structural information and integrate it into the noise predictor for localizing dose regions in the planning target volume (PTV) and organs at risk (OARs). Through extensive experiments on a dataset of 300 thoracic tumor patients, we showcase the superiority of MD-Dose in various metrics and time consumption.

Linjie Fu, Xia Li, Xiuding Cai et al.

Radiation therapy serves as an effective and standard method for cancer treatment. Excellent radiation therapy plans always rely on high-quality dose distribution maps obtained through repeated trial and error by experienced experts. However, due to individual differences and complex clinical situations, even seasoned expert teams may need help to achieve the best treatment plan every time quickly. Many automatic dose distribution prediction methods have been proposed recently to accelerate the radiation therapy planning process and have achieved good results. However, these results suffer from over-smoothing issues, with the obtained dose distribution maps needing more high-frequency details, limiting their clinical application. To address these limitations, we propose a dose prediction diffusion model based on SwinTransformer and a projector, SP-DiffDose. To capture the direct correlation between anatomical structure and dose distribution maps, SP-DiffDose uses a structural encoder to extract features from anatomical images, then employs a conditional diffusion process to blend noise and anatomical images at multiple scales and gradually map them to dose distribution maps. To enhance the dose prediction distribution for organs at risk, SP-DiffDose utilizes SwinTransformer in the deeper layers of the network to capture features at different scales in the image. To learn good representations from the fused features, SP-DiffDose passes the fused features through a designed projector, improving dose prediction accuracy. Finally, we evaluate SP-DiffDose on an internal dataset. The results show that SP-DiffDose outperforms existing methods on multiple evaluation metrics, demonstrating the superiority and generalizability of our method.

Xueyao Wang, Xiuding Cai, Honglin Shang et al.

Early warning of intraoperative adverse events plays a vital role in reducing surgical risk and improving patient safety. While deep learning has shown promise in predicting the single adverse event, several key challenges remain: overlooking adverse event dependencies, underutilizing heterogeneous clinical data, and suffering from the class imbalance inherent in medical datasets. To address these issues, we construct the first Multi-label Adverse Events dataset (MuAE) for intraoperative adverse events prediction, covering six critical events. Next, we propose a novel Transformerbased multi-label learning framework (IAENet) that combines an improved Time-Aware Feature-wise Linear Modulation (TAFiLM) module for static covariates and dynamic variables robust fusion and complex temporal dependencies modeling. Furthermore, we introduce a Label-Constrained Reweighting Loss (LCRLoss) with co-occurrence regularization to effectively mitigate intra-event imbalance and enforce structured consistency among frequently co-occurring events. Extensive experiments demonstrate that IAENet consistently outperforms strong baselines on 5, 10, and 15-minute early warning tasks, achieving improvements of +5.05%, +2.82%, and +7.57% on average F1 score. These results highlight the potential of IAENet for supporting intelligent intraoperative decision-making in clinical practice.

Yingkai Wang, Yaoyao Zhu, Xiuding Cai et al.

Medical image segmentation plays a crucial role in clinical workflows, but domain shift often leads to performance degradation when models are applied to unseen clinical domains. This challenge arises due to variations in imaging conditions, scanner types, and acquisition protocols, limiting the practical deployment of segmentation models. Unlike natural images, medical images typically exhibit consistent anatomical structures across patients, with domain-specific variations mainly caused by imaging conditions. This unique characteristic makes medical image segmentation particularly challenging. To address this challenge, we propose a domain generalization framework tailored for medical image segmentation. Our approach improves robustness to domain-specific variations by introducing implicit feature perturbations guided by domain statistics. Specifically, we employ a learnable semantic direction selector and a covariance-based semantic intensity sampler to modulate domain-variant features while preserving task-relevant anatomical consistency. Furthermore, we design an adaptive consistency constraint that is selectively applied only when feature adjustment leads to degraded segmentation performance. This constraint encourages the adjusted features to align with the original predictions, thereby stabilizing feature selection and improving the reliability of the segmentation. Extensive experiments on two public multi-center benchmarks show that our framework consistently outperforms existing domain generalization approaches, achieving robust and generalizable segmentation performance across diverse clinical domains.

Yaoyao Zhu, Xiuding Cai, Yingkai Wang et al.

Deep learning has achieved remarkable success in medical image classification. However, its clinical application is often hindered by data heterogeneity caused by variations in scanner vendors, imaging protocols, and operators. Approaches such as invariant risk minimization (IRM) aim to address this challenge of out-of-distribution generalization. For instance, VIRM improves upon IRM by tackling the issue of insufficient feature support overlap, demonstrating promising potential. Nonetheless, these methods face limitations in medical imaging due to the scarcity of annotated data and the inefficiency of augmentation strategies. To address these issues, we propose a novel domain-oriented direction selector to replace the random augmentation strategy used in VIRM. Our method leverages inter-domain covariance as a guider for augmentation direction, guiding data augmentation towards the target domain. This approach effectively reduces domain discrepancies and enhances generalization performance. Experiments on a multi-center diabetic retinopathy dataset demonstrate that our method outperforms state-of-the-art approaches, particularly under limited data conditions and significant domain heterogeneity.